title: Is the neutrophil-to-lymphocyte ratio a potential diagnostic marker for peptic ulcer perforation? A retrospective cohort study.
abstract: OBJECTIVE
  Peptic ulcer perforation (PUP) accounts for 5% of all abdominal emergencies and is recognized as a gastrointestinal emergency requiring rapid and efficient clinical evaluation and treatment. The mortality rate ranges from 10% to 40% among patients with perforation. In the present retrospective study, we examined the potential utility of the neutrophil-to-lymphocyte ratio (NLR) in early diagnosis of PUP; we asked whether this ratio allowed PUP and peptic ulcer disease to be distinguished.
  
  
  METHODS
  We enrolled the following patients: 58 with PUP, 62 with noncomplicated peptic ulcer diseases (NCPU), and 62 controls, between May 2010 and 2015. Patients who underwent surgical repair to treat PUP were included in the study group. Another group consisted of NCPU patients who had a noncomplicated peptic ulcer. The control group consisted of patients presenting with nonspecific abdominal pain to the emergency department.
  
  
  RESULTS
  The mortality rate was 5.2% in the PUP group. The white blood cell count, C-reactive protein, and NLRs were higher in the PUP compared to the other groups (P<.001 for all). The white blood cell count and NLR did not differ between the NCPU and control groups. The sensitivities, specificities, positive predictive values, and negative predictive values of the NLRs were 68.0%, 88.0%, 82.9%, and 72.9%, respectively.
  
  
  CONCLUSIONS
  We suggest that preoperative NLR aids in the diagnosis of PUP and can be used to distinguish this condition from peptic ulcer disease. Thus, the NLR should be calculated in addition to the clinical examination.
authors.affiliation: Department of General Surgery, Zonguldak Ataturk State Hospital, Zonguldak, Turkey. Electronic address: drtanrikulu@hotmail.com.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Tanrikulu
authors.affiliation: Department of Emergency Medicine, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey.
authors.forename: Ceren
authors.initials: C
authors.lastname: Sen Tanrikulu
authors.affiliation: Department of General Surgery, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey.
authors.forename: Mehmet Zafer
authors.initials: MZ
authors.lastname: Sabuncuoglu
authors.affiliation: Department of Biostatistics, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey.
authors.forename: Furuzan
authors.initials: F
authors.lastname: Kokturk
authors.affiliation: Department of General Surgery, Zonguldak Ataturk State Hospital, Zonguldak, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Temi
authors.affiliation: Department of Gastroenterology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey.
authors.forename: Ercan
authors.initials: E
authors.lastname: Bicakci
mesh_terms: D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010439:Peptic Ulcer Perforation / Q000097:blood* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity