The Association of Systemic Inflammatory Indices with Alvarado Score-based Risk Stratification in Acute Appendicitis: A Retrospective Study

Aim: This study aimed to evaluate the association between systemic inflammatory indices, including the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), and the Alvarado score for risk stratification in patients presenting to the emergency department with a diagnosis of acute appendicitis (AA). Materials and Methods:This retrospective descriptive study was approved by the Tekirdağ Namık Kemal University Faculty of Medicine Ethic Committee (approval number: 2025.70.04.06, date: 30.07.2025).A total of 69 adult patients who met inclusion criteria and presented with abdominal pain to the emergency department between January 1, 2023, and January 1, 2024 were enrolled.Among the patients, 53.6% were female and 46.4% male, with a mean age of 41.25±17.46years.No significant age difference was observed between genders (p=0.8).The diagnosis of AA was confirmed by contrast-enhanced abdominal computed tomography in all cases.Results: ROC curve analysis was performed to assess the ability of inflammatory indices to discriminate among Alvarado score-defined risk categories.According to these analyses, NLR showed significant discriminatory performance across Alvarado score-defined high-risk categories with p=0.004 and [area under the curve (AUC)=0.8195% confidence interval (CI): 0.71-0.91],and SII did so with p=0.009 and AUC=0.78(95% CI: 0.66-0.90),whereas PLR was less predictive (p=0.16,AUC=0.65).Conclusion: Our findings suggest that SII shows meaningful association with Alvarado score-based risk stratification and should not be interpreted as a standalone diagnostic marker.However, these markers should be used in conjunction with clinical assessment, and larger, multicenter prospective studies are needed to confirm their usefulness.