ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Surgery
Diagnosing Acute Appendicitis in Children with Neutrophil-Lymphocyte Ratio: A Cross-Sectional Study
Provisionally accepted
- 1Faculty of Medicine, Tanta University, Tanta, Egypt
- 2King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
- 3King Faisal Specialist Hospital & Research Centre - Jeddah, Jeddah, Saudi Arabia
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Background: Diagnosing acute appendicitis (AA) in children can be challenging due to atypical symptoms and the difficulty in obtaining a comprehensive history. This study aimed to evaluate the value of neutrophil-to-lymphocyte ratio (NLR) in diagnosing AA in the paediatric population. Methods: This retrospective cross-sectional study involved 200 pediatric patients aged between 0-14 years of both sexes, who underwent appendectomy for suspected acute appendicitis. Data of patients retrieved from the hospital's patient administration system database. We have categorized patients into three clear surgical groups: Group 1: Appendectomy + Normal Appendix (NA) (n=32). Group 2: Appendectomy + Acute Appendicitis (AA) (n=133). Group 3: Appendectomy + Perforated Appendicitis (PA) (n=35). Results: White blood cells (WBCs), neutrophils and NLR were significantly higher in the acute and complicated appendicitis groups than the normal appendix group and in the complicated appendicitis group than the acute appendicitis group. In multivariate regression, WBCs and NLR were associated with AA (P ≤0.001). NLR was associated with complicated appendicitis (P =0.012). NLR can significantly associated with AA and complicated appendicitis respectively at cut-off >1.7 and >3.5 with 74% and 68.57 % sensitivity, and 69% and 56.98 % specificity. Conclusions: NLR is a potentially useful adjunctive and cost-effective diagnostic marker for AA and complicated appendicitis in the pediatric population.
Keywords: acute appendicitis, complicated, pediatric, Neutrophil-to-lymphocyte ratio, White blood cell count
Received: 29 Jun 2025; Accepted: 12 Nov 2025.
Copyright: © 2025 Shalaby, Alawi, Fatani, Alsaggaf and Awad. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mohamed Mahmoud Shalaby, mohamedmshalaby@gmail.com
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