Diagnostic Value of Serum Sodium Level and Neutrophil-to-Lymphocyte Ratio in Predicting Severity of Acute Appendicitis: A Retrospective Cross-Sectional Two-Center Study

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2024-11, Vol.60 (11), p.1844
• Main Authors: Senol, Serdar, Kusak, Mustafa, Özdemir, Dursun Burak, Sendil, Ahmet Murat
• Format: Article
• Language: English
• Subjects: Abscesses; Acute Disease; Adult; Aged; Appendectomy; Appendicitis; Appendicitis - blood; Appendicitis - diagnosis; Appendicitis - surgery; biomarkers; Blood; Cross-Sectional Studies; disease severity; Emergency medical care; Female; Health aspects; Health facilities; Hospitals; Humans; Hyponatremia; Immunosuppressive agents; Information systems; Kidney diseases; Laparoscopy; Leukocytes; Lymphocytes; Male; Medical research; Medicine, Experimental; Middle Aged; Neutrophils; Normal distribution; Patients; Predictive Value of Tests; predictivity; Retrospective Studies; ROC Curve; Severity of Illness Index; Sodium; Sodium - blood; Surgery; Variables
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60111844

: The best way to distinguish complicated acute appendicitis (CAA) from uncomplicated acute appendicitis (UCAA) is still under debate. The aim of this study was to investigate the potential use of the serum sodium (Na ) level and the neutrophil-to-lymphocyte ratio (NLR) to distinguish CAA from UCAA and to evaluate whether CAA is more reliably diagnosed using these two variables together. : This was a retrospective, cross-sectional, two-center study of patients diagnosed with AA between 1 January 2016 and 31 December 2023. The demographic and analytical variables were analyzed. The NLR was defined as the quotient between the absolute values of neutrophils and lymphocytes. Hyponatremia was defined as a serum Na level of ≤135 mmol/L. The sensitivity and specificity of the NLR and the serum Na level in the diagnosis of CAA were determined by assessing the receiver operating characteristic curves. : Among the patients who underwent an appendectomy, 3066 histologically confirmed AA cases were identified and included in this study. The registered data revealed that 348 (11.3%) patients had CAA, and the remaining 2718 (88.7%) patients had UCAA. The mean ages were 49.47 ± 18.97 and 38.16 ± 14.50, respectively ( < 0.001). The analysis revealed an exponential correlation between the NLR and the serum Na level with a moderate degree of agreement with CAA (Cohen's Kappa: 0.461, < 0.001). For CAA, using the NLR and the serum Na level, the areas under the curve and the cutoffs were 0.664, 4.2 with a confidence interval (CI) of 0.647-0.681 and 0.727, 135 mmol/L with a CI of 0.711-0.742, respectively; all these values were significant with a -value of