Title: Diagnostic Value of Leukocyte Count and Neutrophil-to-Lymphocyte Ratio in Patients with Acute Appendicitis at Hasahiesa Emergency Hospital, Gezira State, Sudan (2023)
Authors: Tanzeel Alamin Almahdi Gorashi, Khalid Abdelsamea Mohamedahmed,,, Selma O. M. Abdalla
Volume: 9
Issue: 7
Pages: 46-51
Publication Date: 2025/07/28
Abstract:
Background: Acute appendicitis is one of the most common causes of emergency abdominal surgery worldwide; however, its diagnosis can be challenging, especially in resource-limited settings where advanced imaging modalities are often unavailable. Therefore, identifying reliable and accessible laboratory markers, such as leukocyte count and neutrophil-to-lymphocyte ratio (NLR), is essential to enhance diagnostic accuracy and improve patient outcomes. Objectives: This study aimed to assess the diagnostic utility of leukocyte count and neutrophil-to-lymphocyte ratio (NLR) in patients with acute appendicitis at Hasahiesa Emergency Hospital, Gezira State, Sudan. Methods: A prospective cross-sectional study was conducted on 100 consecutive patients presenting with suspected acute appendicitis at Hasahiesa Emergency Hospital, Gezira State, Sudan, from October 2022 to March 2023. Demographic and clinical data were collected using a structured questionnaire. Peripheral venous blood samples were analyzed for leukocyte count and neutrophil-to-lymphocyte ratio (NLR) using an automated hematology analyzer (Sysmex XP-300). Patients were classified intraoperatively as having uncomplicated or complicated appendicitis based on surgical findings. Data were analyzed using SPSS Statistics version 25 with statistical significance set at p < 0.05. Results: Of the 100 patients enrolled (44% male, 56% female; mean age 22.3 ± 6.8 years), leukocytosis was observed in 55%. The mean NLR was significantly higher in patients with complicated appendicitis (mean 6.2 ± 1.5) compared to those with uncomplicated disease (mean 4.1 ± 1.2) (p < 0.05). Both leukocyte count and NLR demonstrated strong associations with appendicitis severity, supporting their role as effective diagnostic markers. These findings align with previous studies, which report NLR cut-off values ranging from 3.5 to 4.7 for acute appendicitis and higher values, such as 5.7 to 8.8, for complicated cases, with good sensitivity and specificity. Conclusion: Leukocyte count and neutrophil-to-lymphocyte ratio (NLR) are accessible, cost-effective, and reliable biomarkers for both the diagnosis and severity assessment of acute appendicitis. Incorporating these markers into routine clinical practice, particularly in resource-limited settings, has the potential to significantly improve diagnostic accuracy and inform appropriate management strategies for patients with suspected appendicitis.