Systemic inflammatory response index and systemic inflammation index might improve surgical decision making in patients with acute right lower abdominal pain

Objectives
This study tried to assess the distinguishing ability of preoperative clinical scorings and estimated differential leukocytic ratios for patients presenting with acute right lower quadrant (RLQ) pain and requiring surgical intervention.
Patients
A total of 316 patients who had RLQ pain were evaluated clinically and by abdominal ultrasonography, and their blood samples were taken for estimation of total and differential leukocytic count and estimation of serum levels of C-reactive protein. Then, patients received the appropriate surgical procedure. The predictability of the Alvarado score, appendicitis inflammatory score (AIS), Lintula score, the calculated neutrophil/lymphocyte ratio, the systemic inflammatory response index (SIRI), and the systemic inflammation index for operative findings was statistically evaluated.
Results
The Alvarado score showed significantly higher diagnostic performance for appendicitis necessitating appendectomy in comparison with AIS (=0.049) and Lintula score (=0.044). For gynecological pathologies requiring surgical intervention, the diagnostic performance of the Alvarado score was significantly higher than that of AIS. The diagnostic performance of the three leukocyte ratios showed nonsignificant differences. Multivariate regression analysis defined a high SIRI ratio and Alvarado clinical score as the variate that can discriminate cases that required appendectomy and high SIRI and neutrophil/lymphocyte ratios as the significant predictors for gynecological cases requiring surgical intervention. Regression analysis confirmed the ability of low SIRI and low AIS scores to indicate canceling of laparotomy.
Conclusion
Surgical decision making for patients who had RLQ pain could be improved by combining the Alvarado score with the determined differential leukocytic indices.