{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T03:14:22Z","timestamp":1781579662721,"version":"3.54.5"},"reference-count":29,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T00:00:00Z","timestamp":1733875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: This specific study evaluates the accuracy of two ratios, Neutrophil-to-Lymphocyte (N\/L) and Platelet-to-Lymphocyte (P\/L), as inflammatory markers on differentiating simple and complicated appendicitis preoperatively. Methods: The medical records of 341 children, up to 16 years old, with suspected acute appendicitis (AA) who underwent appendectomy, laparoscopic or open, between January 2020 and December 2022, in our department, were retrospectively reviewed. Routine blood exams and the demographic details were obtained. The area under the curve (AUC), sensitivity, and specificity of the above-mentioned markers regarding the differentiation of simple and complicated appendicitis, based on the statistical program SPSS, were calculated. Results: From the total of 341 patients, a percentage of 27.5% were related to perforated appendicitis, such as necrosis or the rupture of the appendiceal wall. A significant association was observed between perforated appendicitis and NLR values &gt; 7.92, with concomitant sensitivity 62.5% and specificity 74.2%. Retrospectively, for PLR values &gt; 180.57, the sensitivity was 61.1% and specificity 68.9%. For these models, the areas under the curve were 0.736 and 0.696. Conclusions: Our study revealed a significant association of N\/L and P\/L ratios with acute perforated appendicitis. Future studies should validate the use of these markers on this disease.<\/jats:p>","DOI":"10.3390\/diagnostics14242777","type":"journal-article","created":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T06:44:05Z","timestamp":1733899445000},"page":"2777","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The Importance of the Neutrophil\u2013Lymphocyte Ratio (NLR) and the Platelet\u2013Lymphocyte Ratio (PLR) as Biomarkers for Differentiating Complicated and Uncomplicated Appendicitis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1763-1162","authenticated-orcid":false,"given":"Michail","family":"Anastasakis","sequence":"first","affiliation":[{"name":"1st Department of Pediatric Surgery, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2486-9474","authenticated-orcid":false,"given":"Ioannis","family":"Trevlias","sequence":"additional","affiliation":[{"name":"1st Department of Pediatric Surgery, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Farmakis","sequence":"additional","affiliation":[{"name":"1st Department of Pediatric Surgery, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2205-3950","authenticated-orcid":false,"given":"Ioannis","family":"Valioulis","sequence":"additional","affiliation":[{"name":"1st Department of Pediatric Surgery, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1159\/000440818","article-title":"The Utility of Neutrophil-to-Lymphocyte Ratio as a Severity Predictor of Acute Appendicitis, Length of Hospital Stay and Postoperative Complication Rates","volume":"32","author":"Kelly","year":"2015","journal-title":"Dig. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s13017-015-0053-2","article-title":"Acute appendicitis: Proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings","volume":"10","author":"Gomes","year":"2015","journal-title":"World J. Emerg. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1002\/ca.22269","article-title":"The vermiform appendix: A Review","volume":"26","author":"Barlow","year":"2013","journal-title":"Clin. Anat."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13017-018-0179-0","article-title":"Prospective observational study on acute appendicitis worldwide (POSAW)","volume":"13","author":"Sartelli","year":"2018","journal-title":"World J. Emerg. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1016\/j.jpedsurg.2023.02.060","article-title":"The Value of the Alvarado Score for the Diagnosis of Acute Appendicitis in Children: A Systematic Review and Meta-Analysis","volume":"58","author":"Bai","year":"2023","journal-title":"J. Pediatr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13017-016-0090-5","article-title":"WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis","volume":"11","author":"Birindelli","year":"2016","journal-title":"World J. Emerg. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00068-022-02208-2","article-title":"Clinical practice selectively follows acute appendicitis guidelines","volume":"49","author":"Bass","year":"2023","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_8","first-page":"764","article-title":"Acute appendicitis in childhood and adulthood: An everyday clinical challenge","volume":"117","author":"Rolle","year":"2020","journal-title":"Dtsch. \u00c4rzteblatt Int."},{"key":"ref_9","first-page":"566","article-title":"Evaluation of systemic immune-inflammation index efficacy in predicting complicated appendicitis in pediatric emergency department","volume":"29","author":"Tekeli","year":"2023","journal-title":"Turk. J. Trauma Emerg. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Anand, S., Krishnan, N., Juki\u0107, M., Kri\u017eanac, Z., Llorente Mu\u00f1oz, C.M., and Pogoreli\u0107, Z. (2022). Utility of Red Cell Distribution Width (RDW) as a Noninvasive Biomarker for the Diagnosis of Acute Appendicitis: A Systematic Review and Meta-Analysis of 5222 Cases. Diagnostics, 12.","DOI":"10.3390\/diagnostics12041011"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Krishnan, N., Anand, S., Pakkasj\u00e4rvi, N., Bajpai, M., Dhua, A.K., and Yadav, D.K. (2022). Mean Platelet Volume in the Diagnosis of Acute Appendicitis in the Pediatric Population: A Systematic Review and Meta-Analysis. Diagnostics, 12.","DOI":"10.3390\/diagnostics12071596"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"423","DOI":"10.5505\/tjtes.2014.75044","article-title":"The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis","volume":"20","author":"Sahbaz","year":"2014","journal-title":"Turk. J. Trauma Emerg. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e15609","DOI":"10.1111\/ped.15609","article-title":"The role of indices in predicting disease severity and outcomes of multisystem inflammatory syndrome in children","volume":"65","author":"Sezer","year":"2023","journal-title":"Pediatr. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"135","DOI":"10.2147\/PHMT.S155302","article-title":"Perforation risk in pediatric appendicitis: Assessment and management","volume":"9","author":"Howell","year":"2018","journal-title":"Pediatr. Health Med. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3126\/njmr.v5i1.44179","article-title":"The Role of Neutrophil Lymphocyte Ratio in Predicting Acute Appendicitis in Adult","volume":"5","author":"Giri","year":"2022","journal-title":"Nepal J. Multidiscip. Res."},{"key":"ref_16","first-page":"e28619","article-title":"Predicting the Severity of Acute Appendicitis in Children Using Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR)","volume":"14","author":"Ayeni","year":"2022","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/ans.12032","article-title":"The value of biochemical markers in predicting a perforation in acute appendicitis","volume":"83","author":"McGowan","year":"2013","journal-title":"ANZ J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e508","DOI":"10.1016\/j.jemermed.2023.11.016","article-title":"The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis in Children","volume":"66","author":"Fennell","year":"2024","journal-title":"J. Emerg. Med."},{"key":"ref_19","first-page":"S161","article-title":"Inflamatory indexes predictors of complicated acute apendicitis in children","volume":"61","year":"2023","journal-title":"Rev. Med. Inst. Mex. Seguro Soc."},{"key":"ref_20","first-page":"76","article-title":"Predictive Value of Neutrophil\/Lymphocyte Ratios in the Diagnosis of Acute Appendicitis","volume":"16","author":"Akyuz","year":"2020","journal-title":"Med. J. Bakirkoy"},{"key":"ref_21","first-page":"257","article-title":"Use of the neutrophil:lymphocyte ratio in the diagnosis of appendicitis","volume":"61","author":"Goodman","year":"1995","journal-title":"Am. Surg."},{"key":"ref_22","first-page":"507","article-title":"Systemic inflammatory markers for distinguishing uncomplicated and complicated acute appendicitis in adult patients","volume":"10","author":"Yesilalioglu","year":"2023","journal-title":"N. Clin. Istanb."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1080\/00015458.2010.11680673","article-title":"The diagnostic value of neutrophil: Lymphocyte ratio in adults with suspected acute appendicitis","volume":"110","author":"Markar","year":"2010","journal-title":"Acta Chir. Belg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1007\/s00595-015-1125-3","article-title":"A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis","volume":"46","author":"Shimizu","year":"2016","journal-title":"Surg. Today"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1111\/ijlh.13768","article-title":"Age- and sex-specific pediatric reference intervals for neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio","volume":"44","author":"Moosmann","year":"2022","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_26","first-page":"557","article-title":"Neutrophilic-lymphocytes and platelet-lymphocytes ratios as predictors for acute perforated appendicitis in children","volume":"78","year":"2021","journal-title":"Bol. Med. Hosp. Infant. Mex."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.amjsurg.2019.04.018","article-title":"Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis","volume":"219","author":"Hajibandeh","year":"2020","journal-title":"Am. J. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5505\/tjtes.2014.20688","article-title":"Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis","volume":"20","author":"Kahramanca","year":"2014","journal-title":"Turk. J. Trauma Emerg. Surg."},{"key":"ref_29","first-page":"317","article-title":"Neutrophil-to-lymphocyte ratio in the diagnosis of acute appendicitis. Assessment of its diagnostic accuracy","volume":"120","year":"2022","journal-title":"Arch. Argent. Pediatr."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/24\/2777\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:52:26Z","timestamp":1760115146000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/24\/2777"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,11]]},"references-count":29,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["diagnostics14242777"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14242777","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,11]]}}}