Evaluation of the diagnostic value of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in diagnosing uncomplicated and complicated appendicitis in children aged 3 to 18 years in patients referred to Ali Ibn Abi Taleb Hospital in Zahedan in 2024-2025

Background: Appendicitis is one of the most frequent abdominal emergencies in children, and making an early and accurate diagnosis is essential to avoid complications like perforation and peritonitis. Because routine lab tests are not always reliable in determining the severity of appendicitis, there is growing interest in finding simple and practical markers that can help distinguish uncomplicated cases from those that are already complicated. Among these markers, the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) have recently gained attention as inexpensive and easily obtainable indicators of inflammation. In this study, we aimed to assess how useful NLR and PLR are in differentiating simple from complicated appendicitis in children admitted to Ali Ibn Abitaleb Hospital in Zahedan. Methods: This prospective cross-sectional study was conducted on 385 children, aged 3 to 18 years, with acute appendicitis. Based on histopathological findings following appendectomy, the patients were categorized into two groups: uncomplicated and complicated appendicitis. Data on neutrophil, lymphocyte, and platelet counts were extracted from pre-operative complete blood count (CBC) tests, and the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) were calculated. Data analysis was performed using Receiver Operating Characteristic (ROC) curve analysis to determine the optimal cut-off values and to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results : 385 pediatric patients aged 3-18 years were diagnosed with complicated appendicitis (n=185) and uncomplicated appendicitis (n=200). The area under the curve (AUC) for NLR and PLR was 0.883 and 0.768, respectively. The optimal cutoff point of NLR for predicting appendicitis was 3.075 with a sensitivity of 75.1%, specificity of 87.5%, and NPV and PPV of 79.2% and 84.8%, respectively. The optimal cutoff point of PLR was 102.185 with a sensitivity of 65.4% and specificity of 80%, and NPV and PPV of 71.4% and 75.2%, respectively. Conclusions: The use of inflammatory indices such as NLR and PLR, due to their easy accessibility and low cost, can help improve diagnostic accuracy and facilitate faster decision-making in the management of pediatric appendicitis when used alongside clinical and paraclinical findings.