Yárnoz Irazábal, María Concepción
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Yárnoz Irazábal
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María Concepción
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Ciencias de la Salud
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Publication Open Access Blood cell indices as predictors of complicated appendicitis: a diagnostic study(Elsevier, 2023-09-29) Moreno Alfonso, Julio César; Molina Caballero, Ada; Yárnoz Irazábal, María Concepción; Pérez Martínez, Alberto; Ciencias de la Salud; Osasun ZientziakBackground: Appendicitis in children is associated with diagnostic complexity leading to delayed diagnosis. Such delays risk progression to complicated appendicitis. This study investigates the potential of cellular indices, including neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-tolymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), to differentiate uncomplicated (UA) from complicated appendicitis (CA). Methods: Diagnostic study of pediatric patients with acute appendicitis admitted to our hospital from 2021 to 2022. NLR, dNLR, PLR and MLR were compared between groups. Results: A total of 182 patients were enrolled: 116 cases with CA (63 % male, age 9.6 +/- 5.5 years) and 66 patients with UA (67 % male, age 10.6 +/- 2.7 years). All blood cell indices were significantly higher in the CA group than in the UA group (p= <0.0001). NLR, dNLR and PLR have a good area under the receiver operating characteristic (ROC) curve, whereas MLR has a regular curve (0.735). PLR was the most accurate predictor of CA with a sensitivity of 60 %, specificity of 85 %, positive predictive value of 88 %, area under the ROC curve of 0.802 (95 % CI 0.737-0.866) and a cut-off point for the diagnosis of CA of 213.3. The post-test probability of CA for a positive result on PLR was 80 % (95 % CI 69-88). Conclusions: PLR seems to be the most accurate cellular index to differentiate uncomplicated from complicated appendicitis in children. It may be useful for prioritizing cases for surgery as a predictor of intraoperative findings and early postoperative courses.Publication Open Access Exploración del papel de los índices celulares de eosinófilos en el diagnóstico de la esofagitis eosinofílica(Elsevier, 2025-06-01) Moreno Alfonso, Julio César; Barbosa-Velásquez, Sharom; Molina Caballero, Ada; Pérez Martínez, Alberto; Yárnoz Irazábal, María Concepción; Ciencias de la Salud; Osasun ZientziakLa esofagitis eosinofílica (EEo) es un trastorno inmunológico del esófago con una respuesta inflamatoria predominantemente eosinofílica. La endoscopia con biopsias es el método de elección para su diagnóstico y seguimiento, pero su naturaleza invasiva, considerable coste y potenciales complicaciones representan una preocupación vigente. Aunque se ha estudiado la utilidad diagnóstica y pronóstica de parámetros no invasivos, como la eosinofilia periférica, los resultados son diversos y la evidencia, insuficiente. Investigaciones recientes han demostrado la aplicabilidad de los índices celulares en diferentes enfermedades gastrointestinales. Estos índices se obtienen fácilmente del hemograma, tienen bajo coste, y, hasta donde sabemos, su papel no ha sido estudiado en la EEo. Se explora la utilidad de los índices celulares derivados de eosinófilos en la EEo mediante un estudio diagnóstico de los pacientes de menos de 15 años tratados con esofagogastroscopia por sospecha de EEo entre 2015 y 2022 en un hospital pediátrico, incluyéndose los pacientes con histopatología normal y aquellos con diagnóstico anatomopatológico de EEo (No. Reg. 3318-0000206).Publication Open Access Diagnostic value of the derived neutrophil-to-lymphocyte ratio for acute appendicitis(Wiley, 2025-03-05) Moreno Alfonso, Julio César; Molina Caballero, Ada; Pérez Martínez, Alberto; Yárnoz Irazábal, María Concepción; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate PublikoaBackground: The diagnosis of appendicitis in children can present several challenges,leading to an increased risk of complications. Herein, we aimed to evaluate the diagnosticvalue of the derived neutrophil-to-lymphocyte ratio (dNLR) as a novel adjunctive diagnostictool for appendicitis.Methods: Diagnostic study of patients with appendicitis and non-surgical abdominal pain(AP) admitted to our hospital between 2020 and 2022. White blood cell count (WBC),neutrophil-to-lymphocyte ratio (NLR), and dNLR were compared between the two groupsof patients.Results: Overall, 202 patients were enrolled: 101 with appendicitis (69% male, age9.9 years) and 101 with AP (56% male, age 9.4 years). WBC, NLR, and dNLR were higherin patients in the appendicitis group than in those in the AP group (16.47 versus11.18 10 3 cells/mm 3; 9.5 versus 3.3; and 5.2 versus 2.3; P ≤ 0.0001, respectively). Thesensitivity, specificity, positive predictive value, area under ROC curve, and cutoff point ofdNLR for the diagnosis of appendicitis were 71%, 74%, 73%, 0.811, and 3.78, respectively.The positive likelihood ratios for WBC, NLR, and dNLR were 1.95, 2.05 and 2.77.Conclusion: dNLR is a novel and noninvasive biomarker with high accuracy for diagnosingappendicitis. Its inclusion as an additional diagnostic tool in clinical practice may aid in determin-ing the need for further studies in cases with ambiguous presentations and a dNLR value ≥3.78.