title: Neutrophil-to-lymphocyte ratio as a diagnostic biomarker for the diagnosis of acute mesenteric ischemia.
abstract: OBJECTIVE
  Due to the diagnostic challenges and dreadful consequences of delayed treatment of acute mesenteric ischemia (AMI), a variety of diagnostic markers have been previously studied. However, the diagnostic value of neutrophil-to-lymphocyte ratio (NLR), which has been suggested to be a predictor of inflammation, has never been studied for AMI.
  
  
  METHODS
  The data of 70 patients who underwent laparotomy (n = 8) and/or bowel resection (n = 62) for AMI (n = 70) between January 2009 and March 2014 were retrospectively analyzed. To investigate the studied parameters' role in the differential diagnosis of AMI, control groups were selected from most common reasons of inflammation-related emergent surgery, acute appendicitis (AA, n = 62) and normal appendix (NA, n = 61). White blood cell (WBC), red cell distribution width (RDW), NLR and mean platelet volume (MPV) values were recorded. Outcome variables of the study were defined as diagnostic and prognostic role of NLR in AMI.
  
  
  RESULTS
  RDW and NLR values were found to be higher in the AMI group than the AA group (p < 0.001 and p < 0.001). Also, WBC and MPV values were higher in the AMI group than the NA group (p = 0.001 and p < 0.001). Combined sensitivity, specificity, positive predictive value and negative predictive value of RDW and NLR for recommended cut-off values were 69.4, 71.2, 57.8 and 80.4 %, respectively.
  
  
  CONCLUSIONS
  High NLR value (>9.9) seems to be a valuable diagnostic marker of acute mesenteric ischemia. Combined use of NLR, RDW and other clinical assessment, could help the diagnosis of AMI, especially in the absence of advanced imaging modalities and expert radiologic interpretation.
authors.affiliation: Department of General Surgery, Samsun Education and Research Hospital, Ilkadim, Samsun, Turkey. recepaktimur@gmail.com.
authors.forename: R
authors.identifier: http://orcid.org/0000-0001-8781-9075
authors.initials: R
authors.lastname: Aktimur
authors.affiliation: Department of General Surgery, Adana Numune Education and Research Hospital, Adana, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Cetinkunar
authors.affiliation: Department of General Surgery, Samsun Education and Research Hospital, Ilkadim, Samsun, Turkey.
authors.forename: K
authors.initials: K
authors.lastname: Yildirim
authors.affiliation: Department of Hematology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: S H
authors.initials: SH
authors.lastname: Aktimur
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Ugurlucan
authors.affiliation: Department of General Surgery, Samsun Education and Research Hospital, Ilkadim, Samsun, Turkey.
authors.forename: N
authors.initials: N
authors.lastname: Ozlem
mesh_terms: D015746:Abdominal Pain; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D065666:Mesenteric Ischemia / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Acute mesenteric ischemia; Diagnosis; Differential diagnosis; Mean platelet volume; Neutrophil-to-lymphocyte ratio; Red cell distribution width