Influence of Nutritional Status on the Diagnostic Capacity of the Neutrophil-to-Lymphocyte Ratio for Complicated Acute Appendicitis in Adults

Roque-Quezada J.C.; Virú-Flores H.M.; Barturen-Julca V.A.; Chavarry-Delgado H.E.; Saldaña-Díaz C.V.; Vega-Vega R.R. · Revista de Cirugia (2026) · DOI: 10.35687/s2452-454920260012789

Resumen

Objective: To evaluate the influence of nutritional status on the diagnostic ability of the neutrophil-lymphocyte ratio (NLR) for acute appendicitis in adults.Method: A cross-sectional, analytical, and retrospective study was conducted at José Casimiro Ulloa Emergency Hospital (2020–2024). 675 adult patients with a confirmed diagnosis of acute appendicitis were included, equally distributed into three BMI groups (normal weight, overweight, and obesity). Automated blood counts were analyzed, and ROC curves, optimal NLR cutoff points, and diagnostic prevalence ratios were calculated. Results: The NLR showed an overall AUC of 76.17% (p < 0.001), with better performance in patients with normal weight (AUC: 83.45%) versus obese patients (AUC: 71.71%). The NLR cutoff was 7.72 in normal weight patients, 8.69 in overweight patients, and 8.87 in obesity. The diagnostic prevalence ratio was higher in normal weight patients (PR: 2.17). The diagnostic yield of the NLR progressively decreased with increasing BMI. Conclusion: Nutritional status significantly influences the diagnostic ability of the Neutrophil-Lymphocyte Ratio for acute appendicitis in adults.