{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:19:39Z","timestamp":1780924779927,"version":"3.54.1"},"reference-count":31,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T00:00:00Z","timestamp":1752364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Introduction: Neutrophil-to-lymphocyte ratio (NLR) is an inflammatory biomarker (hemogram-derived-ratio) related to ischemic-inflammatory diseases. Its usefulness in the diagnosis of pediatric testicular torsion (TT) has recently been reported, although its prognostic implication has not been evaluated. Our aim is to analyze the role of NLR in the evolution of TT in children, determining its potential for predicting the risk of adverse outcomes such as orchiectomy or testicular atrophy. Methods: We performed a retrospective multicentric case-control study in patients with clinical and ultrasound suspicion of TT, in whom surgical testicular examination was performed between 2016\u20132022 in seven pediatric hospitals. Patients\u2019 outcomes were analyzed according to the intraoperative and postoperative evolution (orchiectomy\/testicular atrophy or not). Demographics and clinical, ultrasound and laboratory features at admission were analyzed. Sensitivity and specificity were determined by the area under the curve (AUC) represented on the receiver operating characteristic (ROC) curves. Results: A total of 455 patients (median age 13.2 years; interquartile range 10.6\u201314.4 years) were included, in whom 87 orchiectomies (19.1%) were performed and 34 cases of testicular atrophy (7.5%) were observed during follow-up (median follow-up: 10 months). When comparing clinical, ultrasound and laboratory predictors of both events on ROC curves, NLR was the most sensitive and specific parameter for predicting orchiectomy (AUC = 0.834; p &lt; 0.001), as well as testicular atrophy (AUC = 0.849; p &lt; 0.001). Compared with other parameters, the designed cut-off point of NLR = 5.2 had maximum sensitivity and specificity (82.2% and 77.0%, respectively) for predicting orchiectomy or atrophy after testicular torsion. Conclusions: NLR may be considered the best predictor for the risk of orchiectomy or testicular atrophy following torsion in pediatric patients, helping the identification of high-risk cases. It can be useful both for obtaining more accurate preoperative information on patient prognosis and for closer follow-up of high-risk testicular atrophy patients.<\/jats:p>","DOI":"10.3390\/jpm15070310","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T09:56:54Z","timestamp":1752487014000},"page":"310","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Role of Neutrophil-to-Lymphocyte Ratio as a Predictor of Orchiectomy or Testicular Atrophy After Torsion in Children: A Multicentric Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4994-6898","authenticated-orcid":false,"given":"Carlos","family":"Delgado-Miguel","sequence":"first","affiliation":[{"name":"Pediatric Surgery Department, Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital, 28040 Madrid, Spain"},{"name":"Institute for Health Research IdiPAZ, La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0943-6367","authenticated-orcid":false,"given":"Javier","family":"Arredondo-Montero","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Complejo Asistencial Universitario de Le\u00f3n,   24008 Le\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0414-2888","authenticated-orcid":false,"given":"Julio C\u00e9sar","family":"Moreno-Alfonso","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Navarra University Hospital, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3106-7470","authenticated-orcid":false,"given":"Isabella","family":"Garavis Montagut","sequence":"additional","affiliation":[{"name":"Research Hotbed in General Surgery and Subspecialties, El Bosque University, Bogot\u00e1 110311, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"San Basilio","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Rey Juan Carlos University Hospital, 28933 M\u00f3stoles,  Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noela","family":"Carrera","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Toledo University Hospital, 45007 Toledo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leopoldo","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Est\u00edbalitz","family":"Iraola","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Villalba University Hospital, 28400 Villalba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inmaculada","family":"Ruiz Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Villalba University Hospital, 28400 Villalba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Aguado Roncero","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ennio","family":"Fuentes","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital, 28040 Madrid, Spain"},{"name":"Pediatric Surgery Department, Rey Juan Carlos University Hospital, 28933 M\u00f3stoles,  Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9311-6704","authenticated-orcid":false,"given":"Ricardo","family":"D\u00edez","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital, 28040 Madrid, Spain"},{"name":"Pediatric Surgery Department, Infanta Elena University Hospital, 28342 Valdemoro, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Hern\u00e1ndez-Oliveros","sequence":"additional","affiliation":[{"name":"Institute for Health Research IdiPAZ, La Paz University Hospital, 28046 Madrid, Spain"},{"name":"Pediatric Surgery Department, La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.jpurol.2012.05.016","article-title":"Torsion of spermatic cord in children: A review","volume":"9","year":"2013","journal-title":"J. Pediatr. Urol."},{"key":"ref_2","first-page":"835","article-title":"Testicular torsion: Diagnosis, evaluation, and management","volume":"88","author":"Sharp","year":"2013","journal-title":"Am. Fam. Physician"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.jpurol.2022.01.005","article-title":"Comparison of the outcomes of testicular torsion among children presenting during the Coronavirus Disease 2019 (COVID-19) pandemic versus the pre-pandemic period: A systematic review and meta-analysis","volume":"18","author":"Anand","year":"2022","journal-title":"J. Pediatr. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.21037\/tau.2017.09.10","article-title":"Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion","volume":"6","author":"Howe","year":"2017","journal-title":"Transl. Androl. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"190","DOI":"10.5811\/westjem.2014.11.22495","article-title":"Factors influencing rate of testicular salvage in acute testicular torsion at a tertiary pediatric center","volume":"16","author":"Ramachandra","year":"2015","journal-title":"West. J. Emerg. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1590\/s1677-5538.ibju.2016.0166","article-title":"The amount of spermatic cord rotation magnifies the timerelated orchidectomy risk in intravaginal testicular torsion","volume":"42","author":"Dias","year":"2016","journal-title":"Int. Braz. J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.urology.2011.10.041","article-title":"Clinical predictors of testicular torsion in children","volume":"79","author":"Boettcher","year":"2012","journal-title":"Urology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e13357","DOI":"10.1111\/and.13357","article-title":"Can haematologic parameters be used to predict testicular viability in testicular torsion?","volume":"51","author":"He","year":"2019","journal-title":"Andrologia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e14374","DOI":"10.1111\/and.14374","article-title":"Should haematological inflammatory markers be included as an adjuvant in the differential diagnosis of acute scrotal pathologies?","volume":"54","author":"Yilmaz","year":"2022","journal-title":"Andrologia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1080\/00325481.2020.1807161","article-title":"The relevance of practical laboratory markers in predicting gastrointestinal and renal involvement in children with Henoch-Sch\u00f6nlein Purpura","volume":"133","author":"Tanatar","year":"2021","journal-title":"Postgrad. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"324","DOI":"10.4111\/kju.2015.56.4.324","article-title":"Predictive role of hematologic parameters in testicular torsion","volume":"56","author":"Umul","year":"2015","journal-title":"Korean J. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1055\/a-1913-4280","article-title":"Neutrophil-to-Lymphocyte Ratio as a Predictor of the Need for Surgical Treatment in Children\u2019s Intussusception","volume":"33","author":"Delgado","year":"2023","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jpag.2020.12.003","article-title":"Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio Might Predict Pediatric Ovarian Torsion: A Single-Institution Experience and Review of the Literature","volume":"34","author":"Nissen","year":"2021","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"697.e1","DOI":"10.1016\/j.jpurol.2022.09.010","article-title":"The role of neutrophil-to-lymphocyte ratio as a predictor of testicular torsion in children","volume":"18","year":"2022","journal-title":"J. Pediatr. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s00247-002-0701-z","article-title":"Sonographic diagnosis of acute spermatic cord torsion. Rotation of the cord: A key to the diagnosis","volume":"32","author":"Arce","year":"2002","journal-title":"Pediatr. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"79","DOI":"10.5455\/medarh.2014.68.79-82","article-title":"Testicular volume and testicular atrophy index as predictors of functionality of unilaterally cryptorchid testis","volume":"68","author":"Zvizdic","year":"2014","journal-title":"Med. Arch."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1016\/j.euf.2020.07.006","article-title":"Orchidopexy for Testicular Torsion: A Systematic Review of Surgical Technique","volume":"7","author":"Moore","year":"2021","journal-title":"Eur. Urol. Focus"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1002\/bimj.200410135","article-title":"Estimation of the Youden Index and its associated cutoff point","volume":"47","author":"Fluss","year":"2005","journal-title":"Biom. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1016\/j.jpedsurg.2019.10.023","article-title":"Effect of pediatric testicular torsion on testicular function in the short term","volume":"55","author":"Taskinen","year":"2020","journal-title":"J. Pediatr. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"929285","DOI":"10.1155\/2012\/929285","article-title":"The hypoxic testicle: Physiology and pathophysiology","volume":"2012","author":"Reyes","year":"2012","journal-title":"Oxidative Med. Cell Longev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1111\/bju.13557","article-title":"Treatment patterns, testicular loss and disparities in inpatient surgical management of testicular torsion in boys: A population-based study 1998\u20132010","volume":"118","author":"Sood","year":"2016","journal-title":"BJU Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"300060519895861","DOI":"10.1177\/0300060519895861","article-title":"Management of testicular torsion <360\u00b0 in children: A single-center, retrospective study","volume":"48","author":"Guo","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Tian, X.M., Tan, X.H., Shi, Q.L., Wen, S., Lu, P., Liu, X., Li, X.-L., He, D.-W., Lin, T., and Wei, G.-H. (2020). Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy. Front. Pediatr., 8.","DOI":"10.3389\/fped.2020.584796"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"653","DOI":"10.4103\/aja2021127","article-title":"Long-term follow-up results of testicular torsion in children","volume":"24","author":"Yu","year":"2022","journal-title":"Asian J. Androl."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1055\/s-0035-1566096","article-title":"Factors predicting testicular atrophy after testicular salvage following torsion","volume":"26","author":"Lian","year":"2016","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.jpurol.2013.04.018","article-title":"Do not forget to include testicular torsion in differential diagnosis of lower acute abdominal pain in young males","volume":"9","year":"2013","journal-title":"J. Pediatr. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1111\/bju.12229","article-title":"Clinical and sonographic features predict testicular torsion in children: A prospective study","volume":"112","author":"Boettcher","year":"2013","journal-title":"BJU Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1159\/000506236","article-title":"Clinical Characteristics of Testicular Torsion and Identification of Predictors of Testicular Salvage in Children: A Retrospective Study in a Single Institution","volume":"104","author":"Feng","year":"2020","journal-title":"Urol. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1111\/iju.15420","article-title":"A nomogram for predicting risk factors of testicular salvage after testicular torsion in children","volume":"31","author":"Chen","year":"2024","journal-title":"Int. J. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.urology.2018.03.009","article-title":"Prospective Evaluation of Predictors of Testis Atrophy After Surgery for Testis Torsion in Children","volume":"116","author":"Grimsby","year":"2018","journal-title":"Urology"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/7\/310\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:12Z","timestamp":1760033352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/7\/310"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,13]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jpm15070310"],"URL":"https:\/\/doi.org\/10.3390\/jpm15070310","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,13]]}}}