The lymphocyte-to-monocyte ratio may distinguish complicated from non-complicated pediatric appendicitis: A retrospective study and literature review
Background: To date, no parameter with satisfactory accuracy exists for the diagnosis of appendicitis. This retrospective study describes the discriminatory value of preoperative hematologic factors associated with complicated and non-complicated pediatric appendicitis. Methods: Clinical and laborat...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-03-01
|
| Series: | Pediatrics and Neonatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1875957221002187 |
| _version_ | 1828490339120316416 |
|---|---|
| author | Matthias Nissen Ralf-Bodo Tröbs |
| author_facet | Matthias Nissen Ralf-Bodo Tröbs |
| author_sort | Matthias Nissen |
| collection | DOAJ |
| description | Background: To date, no parameter with satisfactory accuracy exists for the diagnosis of appendicitis. This retrospective study describes the discriminatory value of preoperative hematologic factors associated with complicated and non-complicated pediatric appendicitis. Methods: Clinical and laboratory data were obtained from 294 children diagnosed with appendicitis on admission and treated at our tertiary-level pediatric hospital from 2015 to 2017; they were divided into three groups: control group (n = 118), histologically proven complicated (n = 120), and non-complicated (n = 56) appendicitis. Results: Complicated appendicitis was associated with male preponderance and elevated neutrophil and monocyte levels (all p < 0.001). Non-complicated appendicitis was associated with elevated eosinophil levels (p = 0.023), and unaltered lymphocyte levels (p = 0.30). Compared to non-complicated disease, the lymphocyte-to-monocyte ratio (LMR) was decreased in complicated appendicitis (p = 0.003) but unaltered in the control group (p = 0.38). In the discrimination analysis, LMR had high accuracy (AUC 0.73 ± 0.05; p < 0.001; odds ratio (OR) (95% confidence interval (CI)) 6.0 (2.4–15.3)) and was the only parameter independently associated with complicated appendicitis on regression analysis (OR (95% CI), 0.544 (0.359–0.825); p = 0.004). Conclusion: We identified LMR as a novel potential marker for the differentiation of complicated from non-complicated pediatric appendicitis. This has implications on the treatment approach, either surgical in complicated disease or conservative in non-complicated disease. |
| first_indexed | 2024-12-11T10:41:56Z |
| format | Article |
| id | doaj.art-cbfb6d94607b46649f10317dc986cb5c |
| institution | Directory Open Access Journal |
| issn | 1875-9572 |
| language | English |
| last_indexed | 2024-12-11T10:41:56Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Pediatrics and Neonatology |
| spelling | doaj.art-cbfb6d94607b46649f10317dc986cb5c2022-12-22T01:10:34ZengElsevierPediatrics and Neonatology1875-95722022-03-01632146153The lymphocyte-to-monocyte ratio may distinguish complicated from non-complicated pediatric appendicitis: A retrospective study and literature reviewMatthias Nissen0Ralf-Bodo Tröbs1Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, D-58452, Witten, Germany; Corresponding author. Department of Pediatric Surgery, Marien hospital, St. Elisabeth Group, Ruhr-University of Bochum, Marienplatz 2, D-58452, Witten, Germany.Department of Pediatric Surgery, St. Johannes Hospital, Helios Group, An der Abtei 7-11, D-47166, Duisburg, GermanyBackground: To date, no parameter with satisfactory accuracy exists for the diagnosis of appendicitis. This retrospective study describes the discriminatory value of preoperative hematologic factors associated with complicated and non-complicated pediatric appendicitis. Methods: Clinical and laboratory data were obtained from 294 children diagnosed with appendicitis on admission and treated at our tertiary-level pediatric hospital from 2015 to 2017; they were divided into three groups: control group (n = 118), histologically proven complicated (n = 120), and non-complicated (n = 56) appendicitis. Results: Complicated appendicitis was associated with male preponderance and elevated neutrophil and monocyte levels (all p < 0.001). Non-complicated appendicitis was associated with elevated eosinophil levels (p = 0.023), and unaltered lymphocyte levels (p = 0.30). Compared to non-complicated disease, the lymphocyte-to-monocyte ratio (LMR) was decreased in complicated appendicitis (p = 0.003) but unaltered in the control group (p = 0.38). In the discrimination analysis, LMR had high accuracy (AUC 0.73 ± 0.05; p < 0.001; odds ratio (OR) (95% confidence interval (CI)) 6.0 (2.4–15.3)) and was the only parameter independently associated with complicated appendicitis on regression analysis (OR (95% CI), 0.544 (0.359–0.825); p = 0.004). Conclusion: We identified LMR as a novel potential marker for the differentiation of complicated from non-complicated pediatric appendicitis. This has implications on the treatment approach, either surgical in complicated disease or conservative in non-complicated disease.http://www.sciencedirect.com/science/article/pii/S1875957221002187Conservativetreatment of appendicitisLymphocyte-to-monocyte ratioPediatric complicated appendicitisPediatric non-complicated appendicitisTwo-entity theory of appendicitis |
| spellingShingle | Matthias Nissen Ralf-Bodo Tröbs The lymphocyte-to-monocyte ratio may distinguish complicated from non-complicated pediatric appendicitis: A retrospective study and literature review Pediatrics and Neonatology Conservativetreatment of appendicitis Lymphocyte-to-monocyte ratio Pediatric complicated appendicitis Pediatric non-complicated appendicitis Two-entity theory of appendicitis |
| title | The lymphocyte-to-monocyte ratio may distinguish complicated from non-complicated pediatric appendicitis: A retrospective study and literature review |
| title_full | The lymphocyte-to-monocyte ratio may distinguish complicated from non-complicated pediatric appendicitis: A retrospective study and literature review |
| title_fullStr | The lymphocyte-to-monocyte ratio may distinguish complicated from non-complicated pediatric appendicitis: A retrospective study and literature review |
| title_full_unstemmed | The lymphocyte-to-monocyte ratio may distinguish complicated from non-complicated pediatric appendicitis: A retrospective study and literature review |
| title_short | The lymphocyte-to-monocyte ratio may distinguish complicated from non-complicated pediatric appendicitis: A retrospective study and literature review |
| title_sort | lymphocyte to monocyte ratio may distinguish complicated from non complicated pediatric appendicitis a retrospective study and literature review |
| topic | Conservativetreatment of appendicitis Lymphocyte-to-monocyte ratio Pediatric complicated appendicitis Pediatric non-complicated appendicitis Two-entity theory of appendicitis |
| url | http://www.sciencedirect.com/science/article/pii/S1875957221002187 |
| work_keys_str_mv | AT matthiasnissen thelymphocytetomonocyteratiomaydistinguishcomplicatedfromnoncomplicatedpediatricappendicitisaretrospectivestudyandliteraturereview AT ralfbodotrobs thelymphocytetomonocyteratiomaydistinguishcomplicatedfromnoncomplicatedpediatricappendicitisaretrospectivestudyandliteraturereview AT matthiasnissen lymphocytetomonocyteratiomaydistinguishcomplicatedfromnoncomplicatedpediatricappendicitisaretrospectivestudyandliteraturereview AT ralfbodotrobs lymphocytetomonocyteratiomaydistinguishcomplicatedfromnoncomplicatedpediatricappendicitisaretrospectivestudyandliteraturereview |