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Department of Pediatric Surgery, La Paz Children´s Hospital, Madrid, SpainInstitute for Biomedical Resarch La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
Doppler ultrasound constitutes the gold standard for the diagnosis of testicular torsion
(TT), although sometimes the spermatic cord twisting and absence of testicular flow
are difficult to visualize. To date, no laboratory markers have been shown to be useful
for preoperative TT diagnosis.
Our aim is to analyze the role of the neutrophil-to-lymphocyte ratio (NLR) as a predictor
of pediatric TT.
A retrospective single-center case–control study was performed in patients with ultrasound
suspicion of TT, in whom surgical testicular examination was performed between 2016
and 2020. Patients were divided into two groups according to the intraoperative findings:
TT group (testicular torsion), defined as spermatic cord twisting on itself around
its longitudinal axis at least 360°, and non-TT group (no torsion). Demographics,
clinical, ultrasound and laboratory features at admission were analyzed. Sensitivity
and specificity were determined by the area under the curve (AUC) represented on the
receiver operating characteristic (ROC) curves.
A total of 159 patients were included (117 TT group; 42 non-TT group), with no demographic
or clinical differences. TT group patients presented significantly shorter median
time since symptoms onset (4 vs. 8 h; p < 0.012). Laboratory inflammatory test were
significantly higher in TT group: Leukocytes (10,900 × 103/μl vs. 7,980 × 103/μl; p < 0.001), neutrophils (8,050 × 103/μl vs. 3,350 × 103/μl; p < 0.001) and NLR (4.6 vs. 1.1; p < 0.001). In ROC curve analysis, NLR presented
the highest AUC (0.903), significantly higher than all other laboratory and ultrasound
parameters. NLR of 2.3 was the cut-off point with maximum sensitivity (86.9%) and
This is, to the best of our knowledge, the first study to analyze the usefulness of
NLR in predicting the diagnosis of TT in patients with clinical and ultrasound suspicion.
The limitations are mainly derived from being a single-center retrospective study.
For this reason, multicenter studies with a higher number of patients and prospective
design may be useful to minimize these biases. The sample size of our study, although
not large, has allowed us to identify significant differences between the distinct
parameters analyzed as predictors of TT. However, the absence of other similar studies
in pediatric patients has hindered the comparison of our results.