Background: Acute Appendicitis (AA) is one of the most common causes of acute abdomen in surgical practice. Patients presenting with appendicitis may vary in severity. Accurately diagnosing AA with complications like perforation/gangrene is mandatory to avoid patient related morbidity and mortality.

Objective: The present study aims to differentiate non perforated, simple appendicitis from complicated/perforated appendicitis on the basis of preoperative Neutrophil to Lymphocyte ratio (NLR).

Materials and Methods: This is a retrospective study of 127 patients who underwent appendectomy in DVVPF’s medical college and hospital, Ahmednagar, during December 2016 to November 2018. The present study categorised patients on the basis of histopathological findings into either simple, non perforated AA or complicated and perforated AA. The clinical data and complete blood count with NLR was correlated with histopathological findings. Receiver Operating Characteristic (ROC) curve analysis was used for determining optimal cut-off value of NLR for complicated AA.

Results: Most of the patients with AA were in the age group of 21-30 years with M:F ratio of 1.8:1. Mean NLR of patients with complicated AA was raised (8.08±4.04) compared to non-complicated. Optimal cut-off value of NLR for complicated AA was obtained as 5.52 by Receiver Operating Characteristic (ROC) curve analysis. This value has sensitivity of 71.4% and specificity of 74.7% with Area Under Curve (AUC) of 0.84 and p value of <0.001 which was statistically significant.

Conclusion: The Calculation of NLR from complete blood count is simple, cost effective and easily accessible parameter for determining complicated/perforated AA in resource poor settings.

Keywords: Non-perforated appendix, complicated perforated appendix, Neutrophil to Lymphocyte ratio.

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Dr Shrinivasanand M Patil

Postgraduate student, Department of Pathology, DVVPF’s Medical College and Hospital, Ahmednagar, Maharashtra, India