A Review of WBC Count and Neutrophil/lymphocyte Ratio in Patients with Acute Appendicitis

Choi, Won Jin

Abstract

PURPOSE: The total white blood cell count is an unreliable predictor of appendicitis. We focused on the leukocyte count and neutrophil/lymphocyte ratio related to the severity of inflammation for better preoperative diagnosis.
METHODS
Five hundred and fifty seven patients with acute appendicitis operated at Kangwon National University Hospital were reviewed retrospectively. Cases were classified into 4 groups according to the pathological grade of inflammation, those are focal (AF), suppurative (AS), gangrenous (AG), and no diagnostic abnormality (NDA). The leukocyte count and neutrophil/lymphocyte ratio were compared according to groups and presence of periappendiceal abscess.
RESULTS
Male to female ratio was 1.13: 1 and 2nd and 3rd decades were the most prevalent. Histopathologically, AF cases were 6.3%, AS were 51.29%, AG were 23.9% and NDA were 18.7%. The leukocyte count was abnormally elevated in 411 patients (73.8%). The average counts of leukocyte were different statistically between AS & AG, AF, and NDA (p<0.001) (9,676/mm3 in NDA, 11,591/mm3 in AF, 13,235/mm3 in AS, and 13,601/mm3 in AG). The neutrophil/lymphocyte ratio was 3.11 in NDA, 3.89 in AF, 5.20 in AS, and 6.69 in AG. The value was also statistically significant between NDA & AF, AS, and AG groups (p<0.001). Using an upper limit of 3.5, it was found that there is a linear trend in NA (0.46), AF (0.75), AS (1.94), and AG (5.65) (p<0.001). The leukocyte count of 85 cases with periappendiceal abscess was 13,190/mm3, and that of remains 12,440/mm3 (p>0.05). The average of neutrophil/lymphocyte ratio of 85 cases with periappendiceal abscess was 6.37, and that of remains 4.85 (p<0.001).
CONCLUSIONS
The leukocyte count and neutrophil/lymphocyte ratio may be sensitive parameters for severity of inflammation, and the severity of inflammation in appendix show relation with leukocyte count, and the leukocyte count was valuable for predicting the severity of inflammation in appendix.