Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, serum albumin and prognostic nutritional index as predictors of morbidity in super-elderly patients operated on for acute appendicitis

T. Kalayci, M. Kartal

Department of General Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey. dr.tolgakalayci@gmail.com

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• Surgery

OBJECTIVE: Both life expectancy and the proportion of the population in elderly are increasing. Therefore, the number of cases of acute appendicitis (AA) among the super-elderly population is increasing. In this study, it is aimed to find the correlations between morbidity and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), albumin and prognostic nutritional index (PNI) in super-elderly patients.

PATIENTS AND METHODS: In this retrospective study, we studied super-elderly patients (85 years old and above) who were operated on due to AA between January 2015 and January 2020 at a tertiary health center. After approval by the ethics committee, patients’ preoperative, peroperative and postoperative data were collected. Patients were divided into two groups: the morbidity-positive (+) group and the morbidity-negative (-) group. The differences between the two groups regarding the parameters investigated were evaluated.

RESULTS: 25 super-elderly patients were operated on for AA. There were 7 patients in the morbidity (+) group and 18 in the morbidity (-) group. The area under the curve (AUC) for NLR was 0.476 ([95% CI: 0.215-0.738]; p = 0.856), and the AUC for PLR was 0.444 ([95% CI: 0.193-0.696]; p = 0.672). However, the AUC for PNI was 0.810 ([95% CI: 0.569-1.000]; p = 0.018), and the AUC for albumin was 0.845 ([95% CI: 0.601-1.000]; p = 0.008). At the cut-off value of 3.35 g/dL, albumin’s sensitivity was 88.9% and its specificity was 85.7%. At the cut-off value of 38, PNI’s sensitivity was 94.4% and its specificity was 71.4%.

CONCLUSIONS: The present study found that PNI and albumin values can be used as prognostic factors and have high sensitivity and specificity. Therefore, this study is a leader study in identifying prognostic factors for AA that can be used in the super-elderly geriatric population. However, the possibility of statistical error should be minimized by conducting studies involving more patients.

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