title: The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis.
abstract: OBJECTIVE
  Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by attacks of fever and diffuse abdominal pain. The primary concern with this presentation is to distinguish it from acute appendicitis promptly. Thus, we aimed to evaluate the role of neutrophil lymphocyte ratio (NLR) to leverage the differential diagnosis of acute FMF attack with histologically proven appendicitis.
  
  
  METHODS
  Twenty-three patients with histologically confirmed acute appendicitis and 88 patients with acute attack of FMF were included in the study. NLR, C-reactive protein and other hematologic parameters were compared between the groups.
  
  
  RESULTS
  Neutrophil to lymphocyte ratio was significantly higher in patients with acute appendicitis compared to the FMF attack group (8.24 ± 6.31 vs. 4.16 ± 2.44, p = 0.007). The performance of NLR in diagnosing acute appendicitis with receiver operating characteristic analysis with a cut-off value of 4.03 were; 78% sensitivity, 62% specificity, and area under the curve 0.760 (95% confidence interval, 0.655 to 0.8655; p < 0.001).
  
  
  CONCLUSIONS
  This study showed that NLR, the simple and readily available inflammatory marker may have a useful role in distinguishing acute FMF attack from acute appendicitis.
authors: Division of Rheumatology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey.
authors: Adem
authors: A
authors: Kucuk
authors: Department of General Surgery, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey.
authors: Mehmet Fatih
authors: MF
authors: Erol
authors: Division of Rheumatology, Department of Internal Medicine, Cumhuriyet University, Sivas, Turkey.
authors: Soner
authors: S
authors: Senel
authors: Department of General Surgery, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey.
authors: Emir
authors: E
authors: Eroler
authors: Department of General Surgery, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey.
authors: Havvanur Alparslan
authors: HA
authors: Yumun
authors: Department of Internal Medicine, Cumhuriyet University, Sivas, Turkey.
authors: Ali Ugur
authors: AU
authors: Uslu
authors: Department of Physical Medicine and Rehabilitation, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey.
authors: Asiye Mukaddes
authors: AM
authors: Erol
authors: Department of General Surgery, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey.
authors: Deniz
authors: D
authors: Tihan
authors: Department of General Surgery, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey.
authors: Ugur
authors: U
authors: Duman
authors: Department of General Surgery, Necmettin Erbakan University, Konya, Turkey.
authors: Tevfik
authors: T
authors: Kucukkartallar
authors: Division of Nephrology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey.
authors: Yalcin
authors: Y
authors: Solak
mesh_terms: D000328:Adult; D001064:Appendicitis / Q000097:blood / Q000175:diagnosis*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D003937:Diagnosis, Differential; D010505:Familial Mediterranean Fever / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D009504:Neutrophils; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators
keywords: Abdominal pain; Acute appendicitis; Familial Mediterranean fever attack; Inflammation; Neutrophil-to-lymphocyte ratio