Abstract Introduction: Acute appendicitis is among the most common surgical emergencies, with timely differentiation between simple and complicated forms being critical for management. Conventional diagnostic tools have limitations, prompting interest in inflammatory biomarkers such as the neutrophil-to-lymphocyte ratio (NLR). The aim of the study was to evaluate the diagnostic performance of neutrophil count, lymphocyte count and NLR in differentiating complicated from simple appendicitis and to correlate these findings. Subjects and Methods: This analytical cross-sectional study was conducted on 53 patients undergoing appendectomy at a tertiary care centre. Intraoperative findings and histopathology reports were recorded. Pre-operative complete blood counts were used to calculate neutrophil counts, lymphocyte counts and NLR. Patients were grouped into complicated and simple appendicitis for comparison. Descriptive statistics, independent samples t- test and receiver operating characteristic (ROC) analysis were applied. Results: Of 53 patients, 26 (49.1%) had complicated appendicitis, whereas 27 (50.9%) had simple appendicitis. Histopathology most frequently revealed acute perforative appendicitis with peritonitis (17%). Complicated cases demonstrated higher neutrophils (10,387.5 vs. 8572.9/μL), lower lymphocytes (1164.2 vs. 1656.2/μL; P = 0.005) and a significantly elevated NLR (9.51 vs. 5.59; P < 0.001). ROC analysis showed fair discrimination for neutrophils (area under the curve AUC = 0.769), poor for lymphocytes (AUC = 0.231–0.766) and excellent for NLR (AUC = 0.920). Conclusion: The NLR demonstrated superior diagnostic performance over neutrophil or lymphocyte counts alone, emerging as a rapid, cost-effective biomarker for distinguishing complicated from simple appendicitis. Its incorporation into routine evaluation can improve early risk stratification and guide timely surgical intervention.
Bhate et al. (Wed,) studied this question.