title: The Utility of Neutrophil to Lymphocyte Ratio as a Predictor of Intervention in Acute Diverticulitis.
abstract: BACKGROUND
  Neutrophil to lymphocyte ratio (NLR) is a novel biomarker that has been recently studied in diverticulitis. The primary aim of this study was to assess the accuracy of NLR in predicting which patients had complicated diverticulitis and which patients required a radiological or surgical intervention. The accuracy of NLR was compared to C-reactive protein (CRP), white blood cell (WBC) count, neutrophil count and white cell to lymphocyte ratio (WLR).
  
  
  METHODS
  Details of all patients admitted with acute diverticulitis over an 18-month period were collected prospectively. Median CRP, WBC, neutrophil count, WLR and NLR values at initial presentation were compared using the Mann-Whitney U test. The diagnostic accuracy of each test was assessed using receiver operating characteristic curve analysis. Optimal cut-off points were determined for each biomarker using Youden's Index (J).
  
  
  RESULTS
  CRP, WBC, neutrophil count, WLR and NLR had variable accuracy in predicting complicated diverticulitis. NLR had the greatest accuracy of the 5 biomarkers in predicting the need for intervention with an area under the curve of 0.79 (p < 0.0001). The optimal cut-off point for NLR was 5.34 (J = 0.45).
  
  
  CONCLUSIONS
  NLR was more accurate than CRP, WBC, neutrophil count and WLR in predicting the need for intervention. This cost-neutral, readily available biomarker can easily be calculated from the complete blood count and is a useful adjunct to CT.
authors.affiliation: Department of Surgery, Mayo University Hospital, Castlebar, Co Mayo, Ireland.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Reynolds
authors.forename: Roisin M
authors.initials: RM
authors.lastname: Heaney
authors.forename: Waqar
authors.initials: W
authors.lastname: Khan
authors.forename: Iqbal Z
authors.initials: IZ
authors.lastname: Khan
authors.forename: Ronan
authors.initials: R
authors.lastname: Waldron
authors.forename: Kevin
authors.initials: K
authors.lastname: Barry
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D004239:Diverticulitis, Colonic / Q000097:blood* / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011237:Predictive Value of Tests; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Acute diverticulitis; Biomarker; C-reactive protein; Neutrophil to lymphocyte ratio; White blood cell