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. 2024 Jul 18;14(7):889.
doi: 10.3390/life14070889.

The Role of Neutrophyl-to-Lymphocyte Ratio as a Predictor of Ovarian Torsion in Children: Results of a Multicentric Study

Carlos Delgado-Miguel  1   2 , Javier Arredondo-Montero  3 , Julio César Moreno-Alfonso  4 , María San Basilio  5 , Raquel Peña Pérez  6 , Noela Carrera  7 , Pablo Aguado  1 , Ennio Fuentes  1   6   8 , Ricardo Díez  1   6   8 , Francisco Hernández-Oliveros  2   5
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The Role of Neutrophyl-to-Lymphocyte Ratio as a Predictor of Ovarian Torsion in Children: Results of a Multicentric Study

Carlos Delgado-Miguel et al. Life (Basel). .

Abstract

Introduction: Pediatric ovarian torsion (OT) is an emergency condition that remains challenging to diagnose because of its overall unspecific clinical presentation. The aim of this study was to determine the diagnostic value of clinical, ultrasound, and inflammatory laboratory markers in pediatric OT.

Methods: We performed a retrospective multicentric case-control study in patients with clinical and ultrasound suspicion of OT, in whom surgical examination was performed between 2016-2022 in seven pediatric hospitals. Patients were divided into two groups according to intraoperative findings: OT group (ovarian torsion), defined as torsion of the ovarian axis at least 360°, and non-OT group (no torsion). Demographics, clinical, ultrasound, and laboratory features at admission were analyzed. The diagnostic yield analysis was performed using logistic regression models, and the results were represented by ROC curves.

Results: We included a total of 110 patients (75 in OT group; 35 in non-OT group), with no demographic or clinical differences between them. OT-group patients had shorter time from symptom onset (8 vs. 12 h; p = 0.023), higher ultrasound median ovarian volume (63 vs. 51 mL; p = 0.013), and a significant increase in inflammatory markers (leukocytes, neutrophils, neutrophil-to-lymphocyte ratio, C-reactive protein) when compared to the non-OT group. In the ROC curve analysis, the neutrophil-to-lymphocyte ratio (NLR) presented the highest AUC (0.918), with maximum sensitivity (92.4%) and specificity (90.1%) at the cut-off point NLR = 2.57.

Conclusions: NLR can be considered as a useful predictor of pediatric OT in cases with clinical and ultrasound suspicion. Values above 2.57 may help to anticipate urgent surgical treatment in these patients.

Keywords: children; neutrophil-to-lymphocyte ratio; ovarian torsion; predictive factors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
ROC curves for OT intraoperative diagnosis. NLR, Neutrophil-to-Lymphocyte Ratio; SII, Systemic Immune-Inflammation Index; SIRI, Systemic Inflammation Response Index; WBC, White Blood Cells; PLR, Platelet-to-Lymphocyte Ratio; OVR, ovarian volumen ratio; OV, ovarian volumen; TSSO, time since symptoms onset.
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