USE OF THE NEUTROPHIL - LYMPHOCYTE RATIO IN THE DIAGNOSIS OF APPENDICITIS

In patients with right lower quadrant pain, the total white cell count is an unreliable predictor of appendicitis. It has been reported that the lymphocyte count can fall in acute appendicitis. This study was u ndertaken to investigate whether the neutrophil:lymphocyte ratio is a more sensitive indicator than the total leucocyte count. A retrospecti ve study was performed of patients undergoing appendectomy for suspect ed appendicitis over a 2-year period. A total of 402 patients were ide ntified; histopathology confirmed appendicitis in 367 (91%). Other sig nificant pathology was found in 13 (3.2%). Twenty-two (5.5%) had a his tologically normal appendix and recovered uneventfully with no other d iagnosis being made. A total of 298 (79%) patients with appendicitis h ad an elevated preoperative total white cell count. The neutrophil:lym phocyte ratio was calculated for each patient. Using an upper limit of 3.5:1, it was found that 324 (88%) of patients with appendicitis had a ratio equal to or greater than this value. This was significantly di fferent from the proportion with a raised total leucocyte count (P = 0 .001). We suggest that the simple calculation of the neutrophil:lympho cyte ratio may provide a parameter that is more sensitive than the tot al leucocyte count in the prediction of appendicitis.