Role of laboratory markers in predicting severity of acute appendicitis

Samarth Virmani, Padubidri Santosh Prabhu, P T Sundeep, Vijay Kumar, Samarth Virmani, Padubidri Santosh Prabhu, P T Sundeep, Vijay Kumar

Abstract

Materials and methods: Record of 233 patients under 18 years of age who underwent appendectomy from 2005 to 2014 was evaluated. Based on perioperative findings of the surgeon, the patients were grouped under categories simple acute appendicitis (SAA) and CAA. Information such as age, gender, and laboratory investigations of the patients were recorded and analyzed.

Background: Accurately differentiating simple and complicated acute appendicitis (CAA) in children preoperatively can be challenging. The aim of this study is to evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR), total leukocyte count (TLC), percentage lymphocyte, and percentage neutrophil counts to predict the type of appendicitis a patient has preoperatively and to determine the better indicator among these.

Results: SAA included 185 patients and CAA included 48 patients. An NLR >4.8, TLC >13,500 cells/mm3, percentage lymphocyte count <14.8%, and percentage neutrophil count >75% were found to be associated with complicated appendicitis. The highest sensitivity and specificity among these findings were found with the percentage lymphocyte count, which were 70.8% and 63.8%, respectively.

Conclusion: The preoperative percentage lymphocyte count serves as a better indicator than TLC, NLR, and percentage lymphocyte count and is a useful parameter in differentiating simple and complicated appendicitis and can be used as a valuable adjunct to the surgeon's clinical evaluation.

Keywords: Appendicitis; lymphocyte; neutrophil.

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Receiver operator characteristic curve for total leukocyte count
Figure 2
Figure 2
Receiver operator characteristic curve for neutrophil-to-lymphocyte ratio
Figure 3
Figure 3
Receiver operator characteristic curve for percentage neutrophil count
Figure 4
Figure 4
Receiver operator characteristic curve for percentage lymphocyte count

References

    1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557–64.
    1. Mekhail P, Naguib N, Yanni F, Izzidien A. Appendicitis in paediatric age group: Correlation between preoperative inflammatory markers and postoperative histological diagnosis. Afr J Paediatr Surg. 2011;8:309–12.
    1. Stefanutti G, Ghirardo V, Gamba P. Inflammatory markers for acute appendicitis in children: Are they helpful? J Pediatr Surg. 2007;42:773–6.
    1. Goodman DA, Goodman CB, Monk JS. Use of the neutrophil: Lymphocyte ratio in the diagnosis of appendicitis. Am Surg. 1995;61:257–9.
    1. Markar SR, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: Lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg. 2010;110:543–7.
    1. Yazici M, Ozkisacik S, Oztan MO, Gürsoy H. Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr. 2010;52:400–3.
    1. Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ, et al. Laboratory tests in patients with acute appendicitis. ANZ J Surg. 2006;76:71–4.
    1. Eriksson S, Granström L, Olander B, Pira U. Leucocyte elastase as a marker in the diagnosis of acute appendicitis. Eur J Surg. 1995;161:901–5.
    1. Grönroos JM, Forsström JJ, Irjala K, Nevalainen TJ. Phospholipase A2, C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis. Clin Chem. 1994;40:1757–60.
    1. Lycopoulou L, Mamoulakis C, Hantzi E, Demetriadis D, Antypas S, Giannaki M, et al. Serum amyloid A protein levels as a possible aid in the diagnosis of acute appendicitis in children. Clin Chem Lab Med. 2005;43:49–53.
    1. Caǧlayan F, Cakmak M, Caǧlayan O, Cavuşoglu T. Plasma D-lactate levels in diagnosis of appendicitis. J Invest Surg. 2003;16:233–7.
    1. Kahramanca S, Ozgehan G, Seker D, Gökce EI, Seker G, Tunç G, et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2014;20:19–22.
    1. Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2012;97:299–304.
    1. Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91:28–37.
    1. Guraya SY, Al-Tuwaijri TA, Khairy GA, Murshid KR. Validity of leukocyte count to predict the severity of acute appendicitis. Saudi Med J. 2005;26:1945–7.
    1. Al-Gaithy ZK. Clinical value of total white blood cells and neutrophil counts in patients with suspected appendicitis: Retrospective study. World J Emerg Surg. 2012;7:32.
    1. Hotic N, Hasukic S, Cickusic E, Rifatbegovic Z, Husaric E. Diagnostic value of serum inflammatory markers (Leucocyte count, C reactive protein and neutrophil count) for detection of acute appendicitis in children. Acta Med Saliniana. 2012;41:44–9. [doi: 10.5457/ams. 280.12]
    1. Bickell NA, Aufses AH, Jr, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg. 2006;202:401–6.
    1. Moon HM, Park BS, Moon DJ. Diagnostic value of C-reactive protein in complicated appendicitis. J Korean Soc Coloproctol. 2011;27:122–6.

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