World J Mens Health.  2019 Jan;37(1):99-104. 10.5534/wjmh.180049.

Neutrophil-Lymphocyte Ratio Predicts Organ Salvage in Testicular Torsion with Marginal Diagnostic Delay

• Jang JB
• Ko YH
• Choi JY
• Song PH
• Moon KH
• Jung HC

• KMID: 2429727
• DOI: http://doi.org/10.5534/wjmh.180049

Abstract

PURPOSE
Though prompt diagnosis to minimize symptom duration (SD) is highly associated with organ salvage in cases of testicular torsion (TT), SD is subjective and hard to determine. We thus investigated the clinical implications of systemic inflammatory responses (SIRs) as potential surrogates of SD to improve testis survival.
MATERIALS AND METHODS
Sixty men with TT that underwent immediate operation among orchiectomy and orchiopexy following a visit to a single emergency department were retrospectively enrolled. Mandatory laboratory tests conducted included neutrophil, lymphocyte, and platelet counts.
RESULTS
Mean age and SD was 15.7±3.7 years and 8.27±4.98 hours, respectively. Thirty-eight (63.3%) underwent orchiectomy and the remaining 22 underwent orchiopexy. Leukocytosis (p=0.001) and neutrophil-lymphocyte ratio (NLR, p < 0.001) were significantly lower in the orchiopexy group as was SD (3.27±1.88 vs. 11.16±3.80, p < 0.001). Although multivariate model showed that the only single variable associated with receipt of orchiopexy was SD (odds ratio [OR]=0.259, p < 0.001), it also revealed NLR as a sole SIR associated with SD (B=0.894, p < 0.001). While 93.3% with a SD of within 3 hours underwent orchiopexy, only 26.6% of affected testes were preserved between 3 to 12 hours (n=30). When multivariable analysis was applied to those with window period, NLR alone predicted orchiopexy rather than orchiectomy (p=0.034, OR=0.635, p=0.013). The area under curve between SD (0.882) and NLR (0.756) was similar (p=0.14).
CONCLUSIONS
This study showed NLR independently predicted testis survival by proper surgical correction particularly for patients with marginally delayed diagnosis, which suggest the clinical usefulness for identifying candidates for orchiopexy in emergency setting.

Keyword

Inflammation; Orchiectomy; Orchiopexy; Spermatic cord torsion; Symptom assessment

MeSH Terms

Area Under Curve
Delayed Diagnosis
Diagnosis
Emergencies
Emergency Service, Hospital
Humans
Inflammation
Leukocytosis
Lymphocytes
Male
Neutrophils
Orchiectomy
Orchiopexy
Platelet Count
Retrospective Studies
Spermatic Cord Torsion*
Symptom Assessment
Testis

Figure

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  Fig. 1 The correlation between symptom duration and neutrophil-lymphocyte ratio (NLR).

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  Fig. 2 Receiver operating characteristic curve comparing symptom duration and neutrophil-lymphocyte ratio (NLR) in 33 men with symptom duration within 3 to 12 hours.

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