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 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.