Neutrophil-to-Lymphocyte Ratio as a Predictor of Complicated Acute Appendicitis: A Multicenter Retrospective Study in Tunisia
DOI:
https://doi.org/10.62438/tunismed.v104i09.7074Keywords:
Acute appendicitis, Complicated appendicitis, Neutrophil-to-lymphocyte ratio, NLR, Biomarkers, ROC analysis, Surgical emergency, TunisiaAbstract
Background: Distinguishing complicated from uncomplicated acute appendicitis (AA) at admission remains a clinical challenge with major therapeutic implications. The Neutrophil-to-Lymphocyte Ratio (NLR) has emerged as a promising composite biomarker of systemic inflammatory stress.
Objectives: To evaluate the diagnostic performance of NLR in predicting complicated acute appendicitis (CAA) and determine its optimal cut-off value in a Tunisian surgical population.
Methods: A multicenter retrospective observational study was conducted at the General Surgery departments of CHU Fattouma Bourguiba (Monastir) and CHU Habib Bourguiba (Sfax) over 18 months (June 2024 – December 2025). A total of 380 patients aged ≥16 years who underwent surgery for confirmed AA were included. NLR, PLR, CRP, and WBC were measured at admission. ROC curve analysis was used to assess discriminating performance and determine the optimal cut-off using the Youden index.
Results: Of 380 patients (male-to-female ratio: 1.17; median age: 30 years), 178 (46%) had CAA. NLR was significantly higher in the CAA group (6.2 ± 3.3 vs. 3.7 ± 1.5; p<0.001). ROC analysis revealed an AUROC of 0.75 (95% CI: 0.70–0.80...( abstract truncated at 250 words).
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