Mehmet Zeki ÖĞÜT, Onur AĞ, Bekir SARICIK, Adem TUNÇER, Nizamettin KUTLUER, Ayşe Azak BOZAN, Şeyma Özer KURTOĞLU, Tamer GÜNDOĞDU, Mehmet Buğra BOZAN
Journal of Health Sciences and Medicine - 2026;9(2):323-329
Aims: This study aimed to evaluate the association between preoperative derived neutrophil-to-lymphocyte ratio (dNLR) and negative appendectomy in patients undergoing surgery for acute appendicitis. The secondary aim was to investigate the diagnostic value of preoperative dNLR by examining its differences across the histopathology-based groups. Methods: This retrospective observational study included 669 adult patients who underwent appendectomy for a preoperative diagnosis of acute appendicitis between August 2018 and December 2023 at our hospital. Based on the histopathological results, the patients were categorized into negative appendectomy and positive appendectomy (complicated and uncomplicated) groups. Preoperative complete blood count parameters, including dNLR, were compared between the groups. The diagnostic performance of dNLR was assessed using receiver operating characteristic (ROC) curve analysis. Results: The rate of negative appendectomy was 20.3%. The negative appendectomy group had a significantly lower dNLR, leukocyte count, neutrophil count, and NLR (p<0.001). The dNLR increased progressively from negative appendectomy to uncomplicated appendicitis and further to complicated appendicitis. ROC analysis demonstrated that dNLR had moderate diagnostic performance in distinguishing negative appendectomy, with an area under the ROC curve (AUC) of 0.691 and a cut-off value >=2.67. In the subgroup analysis of complicated cases, the AUC for dNLR was 0.621. Conclusion: This study demonstrated that dNLR was significantly lower in negative appendectomy cases and increased with disease severity. The ability of both dNLR and NLR to differentiate between groups suggests that they may serve as supportive biomarkers in clinical decision-making. Prospective multicenter studies are warranted to further clarify the diagnostic accuracy of the dNLR.
