The Role of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Differentiating Complicated from Uncomplicated Appendicitis in Vindhya Region

Background: Acute appendicitis is one of the most common surgical emergencies presenting to the emergency department. Its wide spectrum of clinical presentations often makes early diagnosis difficult, and differentiating uncomplicated from complicated appendicitis based solely on clinical evaluation remains challenging. Hematologic inflammatory ratios derived from routine blood investigations may provide a simple and reliable adjunct for early risk stratification. Aim: To evaluate the diagnostic value and role of NLR and PLR in distinguishing complicated from uncomplicated appendicitis. Materials and Methods: This retrospective observational study conducted at Shyam Shah Medical College, Rewa, Madhya Pradesh, in Vindhya Region of India; included 000 patients who underwent appendectomy with histopathologically confirmed appendicitis. Patients were classified into uncomplicated and complicated appendicitis groups. Preoperative hematologic parameters were retrieved, and NLR and PLR were calculated. Statistical comparison and receiver operating characteristic (ROC) curve analyses were performed. Results: A total of 100 patients with histopathologically confirmed acute appendicitis were analyzed. Both neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) was significantly higher in patients with complicated appendicitis compared to uncomplicated appendicitis (p < 0.001). Mean NLR was 7.05 ± 2.09 in complicated appendicitis versus 2.79 ± 1.01 in uncomplicated appendicitis, while mean PLR was 24,103.45 ± 8,392.18 and 11,534.62 ± 4,921.37, respectively. ROC curve analysis demonstrated excellent diagnostic accuracy of NLR (AUC = 0.97) and good accuracy of PLR (AUC = 0.85). At an optimal cut-off value of ≥4.1, NLR showed a sensitivity of 94.2%, specificity of 92.0%, PPV of 91.5%, and NPV of 94.6% for predicting complicated appendicitis. Conclusion: Both NLR and PLR are significantly associated with complicated appendicitis; however, NLR is a superior predictor with excellent diagnostic accuracy. Owing to its simplicity, low cost, and wide availability, NLR can serve as a reliable tool for early identification of complicated appendicitis, particularly in resource-limited settings.