{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:45:13Z","timestamp":1793054713413,"version":"4.5.0"},"reference-count":34,"publisher":"International College of Surgeons","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:p>The purpose of this study was to clarify the clinical features most closely associated with gangrenous appendicitis. From among 314 patients who had undergone open appendectomy in our collected database, 222 for whom sufficient data were evaluable were enrolled. The results of univariate analysis revealed that age (\u226440\/&gt;40\u00a0years), sex (female\/male), fever (\u226437\u00b0\/&gt;37\u00b0C), the serum levels of C-reactive protein and albumin, the Glasgow prognostic score (0, 1\/2), and the neutrophil-to-lymphocyte ratio (NLR) (\u22648\/&gt;8) were associated with gangrenous appendicitis. Among these 7 clinical features, multivariate analysis disclosed that age (\u226440\/&gt;40\u00a0years) (odds ratio, 3.435; 95% confidence interval 1.744\u20136.766; <jats:italic>P<\/jats:italic> &lt; 0.001) and NLR (\u22648\/&gt;8) (odds ratio, 3.016; 95% confidence interval 1.535\u20135.926; <jats:italic>P<\/jats:italic> \u200a=\u200a 0.001) were associated with gangrenous appendicitis. The sensitivity and specificity of these two clinical features were 65% and 27%, and 73% and 39%, respectively. NLR (&gt;8) shows a significant association with gangrenous appendicitis in patients undergoing appendectomy.<\/jats:p>","DOI":"10.9738\/cc161.1","type":"journal-article","created":{"date-parts":[[2013,1,8]],"date-time":"2013-01-08T21:26:51Z","timestamp":1357680411000},"page":"299-304","source":"Crossref","is-referenced-by-count":115,"title":["Neutrophil-to-Lymphocyte Ratio Has a Close Association With Gangrenous Appendicitis in Patients Undergoing Appendectomy"],"prefix":"10.9738","volume":"97","author":[{"given":"Mitsuru","family":"Ishizuka","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Kubota","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4721","reference":[{"key":"i0020-8868-97-4-299-Fitzmaurice1","series-title":"Can J Surg","first-page":"6610","article-title":"Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence","volume":"54","author":"Fitzmaurice\n              GJ ,","unstructured":"Fitzmaurice\n              GJ , \n            \n              McWilliams\n              B , \n            \n              Hurreiz\n              H , \n            \n              Epanomeritakis\n              E . \n          \n          Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence . Can J Surg ;54 :6610"},{"key":"i0020-8868-97-4-299-Varadhan1","series-title":"World J Surg","first-page":"199","article-title":"Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis","volume":"34","author":"Varadhan\n              KK ,","unstructured":"Varadhan\n              KK , \n            \n              Humes\n              DJ , \n            \n              Neal\n              KR , \n            \n              Lobo\n              DN . \n          \n          Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis . World J Surg ;34 :199 \u2013209"},{"key":"i0020-8868-97-4-299-Park1","series-title":"Am Surg","first-page":"752","article-title":"Efficacy of short-term antibiotic therapy for consecutive patients with mild appendicitis","volume":"77","author":"Park\n              HC ,","unstructured":"Park\n              HC , \n            \n              Kim\n              BS , \n            \n              Lee\n              BH . \n          \n          Efficacy of short-term antibiotic therapy for consecutive patients with mild appendicitis . Am Surg ;77 :752 \u2013755"},{"key":"i0020-8868-97-4-299-Styrud1","series-title":"World J Surg","first-page":"1033","article-title":"Appendectomy versus antibiotic treatment in acute appendicitis: a prospective multicenter randomized controlled trial","volume":"30","author":"Styrud\n              J ,","year":"2006","unstructured":"Styrud\n              J , \n            \n              Eriksson\n              S , \n            \n              Nilsson\n              I , \n            \n              Ahlberg\n              G , \n            \n              Haapaniemi\n              S , \n            \n              Neovius\n              G\n            \n            et al . \n          Appendectomy versus antibiotic treatment in acute appendicitis: a prospective multicenter randomized controlled trial . World J Surg2006 ;30 :1033 \u20131037"},{"key":"i0020-8868-97-4-299-Eriksson1","series-title":"Br J Surg","first-page":"166","article-title":"Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis","volume":"82","author":"Eriksson\n              S ,","year":"1995","unstructured":"Eriksson\n              S , \n            \n              Granstrom\n              L . \n          \n          Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis . Br J Surg1995 ;82 :166 \u2013169"},{"key":"i0020-8868-97-4-299-Chong1","series-title":"Singapore Med J","first-page":"220","article-title":"Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis","volume":"51","author":"Chong\n              CF ,","unstructured":"Chong\n              CF , \n            \n              Adi\n              MI , \n            \n              Thien\n              A , \n            \n              Suyoi\n              A , \n            \n              Mackie\n              AJ , \n            \n              Tin\n              AS\n            \n            et al . \n          Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis . Singapore Med J ;51 :220 \u2013225"},{"key":"i0020-8868-97-4-299-Jang1","series-title":"Kor J Gastroenterol","first-page":"27","article-title":"Application of alvarado score in patients with suspected appendicitis [in Korean]","volume":"52","author":"Jang\n              SO ,","year":"2008","unstructured":"Jang\n              SO , \n            \n              Kim\n              BS , \n            \n              Moon\n              DJ . \n          \n          Application of alvarado score in patients with suspected appendicitis [in Korean] . Kor J Gastroenterol2008 ;52 :27 \u201331"},{"key":"i0020-8868-97-4-299-Brigand1","series-title":"J Chir (Paris)","first-page":"2","article-title":"The usefulness of scores in the diagnosis of appendicitis [in French]","volume":"146","author":"Brigand\n              C ,","year":"2009","unstructured":"Brigand\n              C , \n            \n              Steinmetz\n              JP , \n            \n              Rohr\n              S . \n          \n          The usefulness of scores in the diagnosis of appendicitis [in French] . J Chir (Paris)2009 ;146 :2 \u20137"},{"key":"i0020-8868-97-4-299-AlKhayal1","series-title":"Saudi Med J","first-page":"173","article-title":"Computed tomography and ultrasonography in the diagnosis of equivocal acute appendicitis. A meta-analysis","volume":"28","author":"Al-Khayal\n              KA ,","year":"2007","unstructured":"Al-Khayal\n              KA , \n            \n              Al-Omran\n              MA . \n          \n          Computed tomography and ultrasonography in the diagnosis of equivocal acute appendicitis. A meta-analysis . Saudi Med J2007 ;28 :173 \u2013180"},{"key":"i0020-8868-97-4-299-Terasawa1","series-title":"Ann Intern Med","first-page":"537","article-title":"Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents","volume":"141","author":"Terasawa\n              T ,","year":"2004","unstructured":"Terasawa\n              T , \n            \n              Blackmore\n              CC , \n            \n              Bent\n              S , \n            \n              Kohlwes\n              RJ . \n          \n          Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents . Ann Intern Med2004 ;141 :537 \u2013546"},{"key":"i0020-8868-97-4-299-Parks1","series-title":"Surg Clin North Am","first-page":"141","article-title":"Update on imaging for acute appendicitis","volume":"91","author":"Parks\n              NA ,","unstructured":"Parks\n              NA , \n            \n              Schroeppel\n              TJ . \n          \n          Update on imaging for acute appendicitis . Surg Clin North Am ;91 :141 \u2013154"},{"key":"i0020-8868-97-4-299-RodriguezSanjuan1","series-title":"Dis Colon Rectum","first-page":"1325","article-title":"C-reactive protein and leukocyte count in the diagnosis of acute appendicitis in children","volume":"42","author":"Rodriguez-Sanjuan\n              JC ,","year":"1999","unstructured":"Rodriguez-Sanjuan\n              JC , \n            \n              Martin-Parra\n              JI , \n            \n              Seco\n              I , \n            \n              Garcia-Castrillo\n              L , \n            \n              Naranjo\n              A . \n          \n          C-reactive protein and leukocyte count in the diagnosis of acute appendicitis in children . Dis Colon Rectum1999 ;42 :1325 \u20131329"},{"key":"i0020-8868-97-4-299-Keskek1","series-title":"Am J Emerg Med","first-page":"769","article-title":"Receiver operating characteristic analysis of leukocyte counts in operations for suspected appendicitis","volume":"26","author":"Keskek\n              M ,","year":"2008","unstructured":"Keskek\n              M , \n            \n              Tez\n              M , \n            \n              Yoldas\n              O , \n            \n              Acar\n              A , \n            \n              Akgul\n              O , \n            \n              Gocmen\n              E\n            \n            et al . \n          Receiver operating characteristic analysis of leukocyte counts in operations for suspected appendicitis . Am J Emerg Med2008 ;26 :769 \u2013772"},{"key":"i0020-8868-97-4-299-Shafi1","series-title":"Saudi J Gastroenterol","first-page":"117","article-title":"Total leucocyte count, C-reactive protein and neutrophil count: diagnostic aid in acute appendicitis","volume":"15","author":"Shafi\n              SM ,","year":"2009","unstructured":"Shafi\n              SM , \n            \n              Afsheen\n              M , \n            \n              Reshi\n              FA . \n          \n          Total leucocyte count, C-reactive protein and neutrophil count: diagnostic aid in acute appendicitis . Saudi J Gastroenterol2009 ;15 :117 \u2013120"},{"key":"i0020-8868-97-4-299-Albayrak1","series-title":"Clin Appl Thromb Hemost","first-page":"362","article-title":"Mean platelet volume: a new predictor in confirming acute appendicitis diagnosis","volume":"17","author":"Albayrak\n              Y ,","year":"2011","unstructured":"Albayrak\n              Y , \n            \n              Albayrak\n              A , \n            \n              Albayrak\n              F , \n            \n              Yildirim\n              R , \n            \n              Aylu\n              B , \n            \n              Uyanik\n              A\n            \n            et al . \n          Mean platelet volume: a new predictor in confirming acute appendicitis diagnosis . Clin Appl Thromb Hemost2011 ;17 :362 \u2013366"},{"key":"i0020-8868-97-4-299-Goodman1","series-title":"Am Surg","first-page":"257","article-title":"Use of the neutrophil:lymphocyte ratio in the diagnosis of appendicitis","volume":"61","author":"Goodman\n              DA ,","year":"1995","unstructured":"Goodman\n              DA , \n            \n              Goodman\n              CB , \n            \n              Monk\n              JS . \n          \n          Use of the neutrophil:lymphocyte ratio in the diagnosis of appendicitis . Am Surg1995 ;61 :257 \u2013259"},{"key":"i0020-8868-97-4-299-Markar1","series-title":"Acta Chir Belg","first-page":"543","article-title":"The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis","volume":"110","author":"Markar\n              SR ,","unstructured":"Markar\n              SR , \n            \n              Karthikesalingam\n              A , \n            \n              Falzon\n              A , \n            \n              Kan\n              Y . \n          \n          The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis . Acta Chir Belg ;110 :543 \u2013547"},{"key":"i0020-8868-97-4-299-Gurleyik1","series-title":"Dis Colon Rectum","first-page":"1270","article-title":"Accuracy of serum C-reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression","volume":"38","author":"Gurleyik\n              E ,","year":"1995","unstructured":"Gurleyik\n              E , \n            \n              Gurleyik\n              G , \n            \n              Unalmiser\n              S . \n          \n          Accuracy of serum C-reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression . Dis Colon Rectum1995 ;38 :1270 \u20131274"},{"key":"i0020-8868-97-4-299-Yokoyama1","series-title":"World J Emerg Surg","first-page":"36","article-title":"C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study","volume":"4","author":"Yokoyama\n              S ,","year":"2009","unstructured":"Yokoyama\n              S , \n            \n              Takifuji\n              K , \n            \n              Hotta\n              T , \n            \n              Matsuda\n              K , \n            \n              Nasu\n              T , \n            \n              Nakamori\n              M\n            \n            et al . \n          C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study . World J Emerg Surg2009 ;4 :36"},{"key":"i0020-8868-97-4-299-Karoui1","series-title":"Dig Dis Sci","first-page":"1801","article-title":"Correlation of C-reactive protein with clinical and endoscopic activity in patients with ulcerative colitis","volume":"56","author":"Karoui\n              S ,","year":"2011","unstructured":"Karoui\n              S , \n            \n              Laz\n              S , \n            \n              Serghini\n              M , \n            \n              Bibani\n              N , \n            \n              Boubaker\n              J , \n            \n              Filali\n              A . \n          \n          Correlation of C-reactive protein with clinical and endoscopic activity in patients with ulcerative colitis . Dig Dis Sci2011 ;56 :1801 \u20131805"},{"key":"i0020-8868-97-4-299-Dahl1","series-title":"Am J Respir Crit Care Med","first-page":"250","article-title":"C-reactive protein as a predictor of prognosis in chronic obstructive pulmonary disease","volume":"175","author":"Dahl\n              M ,","year":"2007","unstructured":"Dahl\n              M , \n            \n              Vestbo\n              J , \n            \n              Lange\n              P , \n            \n              Bojesen\n              SE , \n            \n              Tybjaerg-Hansen\n              A , \n            \n              Nordestgaard\n              BG . \n          \n          C-reactive protein as a predictor of prognosis in chronic obstructive pulmonary disease . Am J Respir Crit Care Med2007 ;175 :250 \u2013255"},{"key":"i0020-8868-97-4-299-Ishizuka1","series-title":"J Surg Oncol","first-page":"38","article-title":"Systemic inflammatory response predicts postoperative outcome in patients with liver metastases from colorectal cancer","volume":"100","author":"Ishizuka\n              M ,","year":"2009","unstructured":"Ishizuka\n              M , \n            \n              Kita\n              J , \n            \n              Shimoda\n              M , \n            \n              Rokkaku\n              K , \n            \n              Kato\n              M , \n            \n              Sawada\n              T\n            \n            et al . \n          Systemic inflammatory response predicts postoperative outcome in patients with liver metastases from colorectal cancer . J Surg Oncol2009 ;100 :38 \u201342"},{"key":"i0020-8868-97-4-299-Forrest1","series-title":"Br J Cancer","first-page":"1704","article-title":"Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer","volume":"90","author":"Forrest\n              LM ,","year":"2004","unstructured":"Forrest\n              LM , \n            \n              McMillan\n              DC , \n            \n              McArdle\n              CS , \n            \n              Angerson\n              WJ , \n            \n              Dunlop\n              DJ . \n          \n          Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer . Br J Cancer2004 ;90 :1704 \u20131706"},{"key":"i0020-8868-97-4-299-Forrest2","series-title":"Br J Cancer","first-page":"1834","article-title":"A prospective longitudinal study of performance status, an inflammation-based score (GPS) and survival in patients with inoperable non-small-cell lung cancer","volume":"92","author":"Forrest\n              LM ,","year":"2005","unstructured":"Forrest\n              LM , \n            \n              McMillan\n              DC , \n            \n              McArdle\n              CS , \n            \n              Angerson\n              WJ , \n            \n              Dagg\n              K , \n            \n              Scott\n              HR . \n          \n          A prospective longitudinal study of performance status, an inflammation-based score (GPS) and survival in patients with inoperable non-small-cell lung cancer . Br J Cancer2005 ;92 :1834 \u20131836"},{"key":"i0020-8868-97-4-299-Lee1","article-title":"Laparoscopic vs open appendectomy in children: outcomes comparison based on age, sex, and perforation status","author":"Lee\n              SL ,","unstructured":"Lee\n              SL , \n            \n              Yaghoubian\n              A , \n            \n              Kaji\n              A . \n          \n          Laparoscopic vs open appendectomy in children: outcomes comparison based on age, sex, and perforation status . Arch Surg 2011, Epub ahead of print"},{"key":"i0020-8868-97-4-299-Kraemer1","series-title":"Langenbeck's Arch Surg","first-page":"470","article-title":"Acute appendicitis in late adulthood: incidence, presentation, and outcome. Results of a prospective multicenter acute abdominal pain study and a review of the literature","volume":"385","author":"Kraemer\n              M ,","year":"2000","unstructured":"Kraemer\n              M , \n            \n              Franke\n              C , \n            \n              Ohmann\n              C , \n            \n              Yang\n              Q . \n          \n          Acute appendicitis in late adulthood: incidence, presentation, and outcome. Results of a prospective multicenter acute abdominal pain study and a review of the literature . Langenbeck's Arch Surg2000 ;385 :470 \u2013481"},{"key":"i0020-8868-97-4-299-Korner1","series-title":"World J Surg","first-page":"313","article-title":"Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis","volume":"21","author":"Korner\n              H ,","year":"1997","unstructured":"Korner\n              H , \n            \n              Sondenaa\n              K , \n            \n              Soreide\n              JA , \n            \n              Andersen\n              E , \n            \n              Nysted\n              A , \n            \n              Lende\n              TH\n            \n            et al . \n          Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis . World J Surg1997 ;21 :313 \u2013317"},{"key":"i0020-8868-97-4-299-Sack1","series-title":"BMC Surg","first-page":"15","article-title":"Diagnostic value of blood inflammatory markers for detection of acute appendicitis in children","volume":"6","author":"Sack\n              U ,","year":"2006","unstructured":"Sack\n              U , \n            \n              Biereder\n              B , \n            \n              Elouahidi\n              T , \n            \n              Bauer\n              K , \n            \n              Keller\n              T , \n            \n              Trobs\n              RB . \n          \n          Diagnostic value of blood inflammatory markers for detection of acute appendicitis in children . BMC Surg2006 ;6 :15"},{"key":"i0020-8868-97-4-299-Luckmann1","series-title":"Epidemiology","first-page":"323","article-title":"The epidemiology of acute appendicitis in California: racial, gender, and seasonal variation","volume":"2","author":"Luckmann\n              R ,","year":"1991","unstructured":"Luckmann\n              R , \n            \n              Davis\n              P . \n          \n          The epidemiology of acute appendicitis in California: racial, gender, and seasonal variation . Epidemiology1991 ;2 :323 \u2013330"},{"key":"i0020-8868-97-4-299-Cardall1","series-title":"Acad Emerg Med","first-page":"1021","article-title":"Clinical value of the total white blood cell count and temperature in the evaluation of patients with suspected appendicitis","volume":"11","author":"Cardall\n              T ,","year":"2004","unstructured":"Cardall\n              T , \n            \n              Glasser\n              J , \n            \n              Guss\n              DA . \n          \n          Clinical value of the total white blood cell count and temperature in the evaluation of patients with suspected appendicitis . Acad Emerg Med2004 ;11 :1021 \u20131027"},{"key":"i0020-8868-97-4-299-Lee2","series-title":"Am Surg","first-page":"409","article-title":"Acute appendicitis: is there a difference between children and adults","volume":"72","author":"Lee\n              SL ,","year":"2006","unstructured":"Lee\n              SL , \n            \n              Ho\n              HS . \n          \n          Acute appendicitis: is there a difference between children and adults ? Am Surg2006 ;72 :409 \u2013413"},{"key":"i0020-8868-97-4-299-Ishizuka2","series-title":"Ann Surg","first-page":"1047","article-title":"Inflammation-based prognostic score is a novel predictor of postoperative outcome in patients with colorectal cancer","volume":"246","author":"Ishizuka\n              M ,","year":"2007","unstructured":"Ishizuka\n              M , \n            \n              Nagata\n              H , \n            \n              Takagi\n              K , \n            \n              Horie\n              T , \n            \n              Kubota\n              K . \n          \n          Inflammation-based prognostic score is a novel predictor of postoperative outcome in patients with colorectal cancer . Ann Surg2007 ;246 :1047 \u20131051"},{"key":"i0020-8868-97-4-299-Ramsey1","series-title":"Cancer","first-page":"205","article-title":"Evaluation of an inflammation-based prognostic score in patients with metastatic renal cancer","volume":"109","author":"Ramsey\n              S ,","year":"2007","unstructured":"Ramsey\n              S , \n            \n              Lamb\n              GW , \n            \n              Aitchison\n              M , \n            \n              Graham\n              J , \n            \n              McMillan\n              DC . \n          \n          Evaluation of an inflammation-based prognostic score in patients with metastatic renal cancer . Cancer2007 ;109 :205 \u2013212"},{"key":"i0020-8868-97-4-299-Heverhagen1","series-title":"J Magn Reason Imaging","first-page":"617","article-title":"Diagnostic accuracy of magnetic resonance imaging: a retrospective evaluation of patients with suspected appendicitis (diamond)","volume":"35","author":"Heverhagen\n              JT ,","year":"2012","unstructured":"Heverhagen\n              JT , \n            \n              Pfestroff\n              K , \n            \n              Heverhagen\n              AE , \n            \n              Klose\n              KJ , \n            \n              Kessler\n              K , \n            \n              Sitter\n              H . \n          \n          Diagnostic accuracy of magnetic resonance imaging: a retrospective evaluation of patients with suspected appendicitis (diamond) . 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