Neutrophil-Lymphocyte Ratio Predicts Organ Salvage in Testicular Torsion with Marginal Diagnostic Delay

• Main Authors: Jun Bo Jang, Young Hwii Ko, Jae Young Choi, Phil Hyun Song, Ki Hak Moon, Hee Chang Jung
• Format: Article
• Language: English
• Published: Korean Society for Sexual Medicine and Andrology 2019-01-01
• Series: The World Journal of Men's Health
• Subjects: Inflammation; Orchiectomy; Orchiopexy; Spermatic cord torsion; Symptom assessment
• ISSN: 2287-4208; 2287-4690

Purpose: Though prompt diagnosis to minimize symptom duration (SD) is highly associated with organ salvage in cases of testicular torsion (TT), SD is subjective and hard to determine. We thus investigated the clinical implications of systemic in-flammatory responses (SIRs) as potential surrogates of SD to improve testis survival. Materials and Methods: Sixty men with TT that underwent immediate operation among orchiectomy and orchiopexy follow-ing a visit to a single emergency department were retrospectively enrolled. Mandatory laboratory tests conducted included neutrophil, lymphocyte, and platelet counts. Results: Mean age and SD was 15.7±3.7 years and 8.27±4.98 hours, respectively. Thirty-eight (63.3%) underwent orchiec-tomy and the remaining 22 underwent orchiopexy. Leukocytosis (p=0.001) and neutrophil-lymphocyte ratio (NLR, p<0.001) were significantly lower in the orchiopexy group as was SD (3.27±1.88 vs. 11.16±3.80, p<0.001). Although multivariate model showed that the only single variable associated with receipt of orchiopexy was SD (odds ratio [OR]=0.259, p<0.001), it also revealed NLR as a sole SIR associated with SD (B=0.894, p<0.001). While 93.3% with a SD of within 3 hours under-went orchiopexy, only 26.6% of affected testes were preserved between 3 to 12 hours (n=30). When multivariable analysis was applied to those with window period, NLR alone predicted orchiopexy rather than orchiectomy (p=0.034, OR=0.635, p=0.013). The area under curve between SD (0.882) and NLR (0.756) was similar (p=0.14). Conclusions: This study showed NLR independently predicted testis survival by proper surgical correction particularly for patients with marginally delayed diagnosis, which suggest the clinical usefulness for identifying candidates for orchiopexy in emergency setting.