The Value of Complete Blood Count Parameters in Predicting Complicated Acute Appendicitis; a Prognostic Accuracy Study
学术急诊医学档案,
卷 11 编号 1 (2023),
15 八月 2022
,
第 e42 页
https://doi.org/10.22037/aaem.v11i1.2020
摘要
Introduction: Low accuracy of clinical variables can result in delayed diagnosis and increase the incidence of complicated appendicitis in some cases. This study aimed to determine the value of simple complete blood count (CBC) biomarkers in predicting complicated appendicitis.
Methods: This is a single-center retrospective cross-sectional study, which was conducted on cases referred to emergency department following acute appendicitis who underwent appendectomy, to evaluate the accuracy of some cell blood count variables (white blood cell count (WBC), neutrophil percent, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV)) in predicting complicated cases (gangrenous and ruptured appendicitis).
Results: There were 252 (68.3%) patients in the uncomplicated appendicitis group and 117 (31.7%) patients in the complicated appendicitis group. The mean age of patients was 34.1 ± 1.09 (Range: 18 -79) years (55.3% male). There were no differences between groups regarding the mean age (p = 0.053), gender distribution (p=0.07), Alvarado score (p = 0.055), platelet count (p =0.204), PLR (p = 0.115), and MPV (p = 0.205). The complicated appendicitis cases had longer onset of symptoms (p <0.001), higher WBC count (p = 0.011), higher neutrophil count (p < 0.001), and higher NLR (p < 0.001).
Neutrophil count (area under the curve (AUC) = 0.61, 95% confidence interval (CI) = 0.56-0.66; p = 0.001) and NLR (AUC = 0.65, 95% CI = 0.60-0.69; p = 0.001) had higher level of accuracy in this regard. In contrast, the area under the curve of WBC count (AUC = 0.57, 95% CI = 0.52-0.63; p = 0.22), platelet count (AUC = 0.44, 95% CI = 0.38-0.49; p = 0.049), PLR (AUC = 0.57, 95% CI = 0.52-0.62; p = 0.026), and MPV (AUC = 0.54, 95% CI = 0.49-0.60; p = 0.193) showed low accuracy in predicting complicated acute appendicitis.
Conclusion: Based on the findings of present study it seems that WBC, neutrophil percent, NLR, PLR, and MPV have failed to poor accuracy in predicting cases with complicated appendicitis in emergency department.
- Appendicitis
- Biomarkers
- Leukocyte Count
- Emergencies
##submission.howToCite##
参考
Wickramasinghe DP, Xavier C, Samarasekera DN. The Worldwide Epidemiology of Acute Appendicitis: An Analysis of the Global Health Data Exchange Dataset. World J Surg. 2021;45(7):1999-2008.
Krzyzak M, Mulrooney SM. Acute Appendicitis Review: Background, Epidemiology, Diagnosis, and Treatment. Cureus. 2020;12(6):e8562.
Memon ZA, Irfan S, Fatima K, Iqbal MS, Sami W. Acute appendicitis: diagnostic accuracy of Alvarado scoring system. Asian J Surg. 2013;36(4):144-9.
Jalil A, Shah SA, Saaiq M, Zubair M, Riaz U, Habib Y. Alvarado scoring system in prediction of acute appendicitis. J Coll Physicians Surg Pak. 2011;21(12):753-5.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.
Bom WJ, Scheijmans JCG, Salminen P, Boermeester MA. Diagnosis of Uncomplicated and Complicated Appendicitis in Adults. Scand J Surg. 2021;110(2):170-9.
Yamada T, Endo H, Hasegawa H, Kimura T, Kakeji Y, Koda K, et al. Risk of emergency surgery for complicated appendicitis: Japanese nationwide study. Ann Gastroenterol Surg. 2021;5(2):236-42.
Lietzén E, Salminen P, Rinta-Kiikka I, Paajanen H, Rautio T, Nordström P, et al. The Accuracy of the Computed Tomography Diagnosis of Acute Appendicitis: Does the Experience of the Radiologist Matter? Scand J Surg. 2018;107(1):43-7.
Acharya A, Markar SR, Ni M, Hanna GB. Biomarkers of acute appendicitis: systematic review and cost-benefit trade-off analysis. Surg Endosc. 2017;31(3):1022-31.
Aydin OU, Soylu L, Dandin O, Uysal Aydin E, Karademir S. Laboratory in complicated appendicitis prediction and predictive value of monitoring. Bratisl Lek Listy. 2016;117(12):697-701.
Liao YT, Huang J, Wu CT, Chen PC, Hsieh TT, Lai F, et al. The necessity of abdominal drainage for patients with complicated appendicitis undergoing laparoscopic appendectomy: a retrospective cohort study. World J Emerg Surg. 2022;17(1):16.
Athanasios M, Eleni-Aikaterini N, Theodoros T. Complicated Appendicitis: A Surgical Controversy Concerning Risk Factors, Diagnostic Algorithm and Therapeutic Management. In: Angelo G, editor. Doubts, Problems and Certainties about Acute Appendicitis. Rijeka: IntechOpen; 2022. p. Ch. 6.
Barreto SG, Travers E, Thomas T, Mackillop C, Tiong L, Lorimer M, et al. Acute perforated appendicitis: an analysis of risk factors to guide surgical decision making. Indian J Med Sci. 2010;64(2):58-65.
Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91(1):28-37.
Şahbaz NA, Bat O, Kaya B, Ulukent SC, İlkgül Ö, Özgün MY, et al. The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis. Ulus Travma Acil Cerrahi Derg. 2014;20(6):423-6.
Sevinç MM, Kınacı E, Çakar E, Bayrak S, Özakay A, Aren A, et al. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: an analysis of 3392 cases. Ulus Travma Acil Cerrahi Derg. 2016;22(2):155-62.
Shimizu T, Ishizuka M, Kubota K. A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis. Surg Today. 2016;46(1):84-9.
Hajibandeh S, Hobbs N, Mansour M. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis. Am J Surg. 2020;219(1):154-63.
Celik B, Nalcacioglu H, Ozcatal M, Altuner Torun Y. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department. Ulus Travma Acil Cerrahi Derg. 2019;25(3):222-8.
Tullavardhana T, Sanguanlosit S, Chartkitchareon A. Role of platelet indices as a biomarker for the diagnosis of acute appendicitis and as a predictor of complicated appendicitis: A meta-analysis. Ann Med Surg (Lond). 2021;66:102448.
Boshnak N, Boshnaq M, Elgohary H. Evaluation of Platelet Indices and Red Cell Distribution Width as New Biomarkers for the Diagnosis of Acute Appendicitis. J Invest Surg. 2018;31(2):121-9.
- 摘要 ##plugins.themes.ojsPlusA.frontend.article.viewed##: 736 ##plugins.themes.ojsPlusA.frontend.article.times##
- pdf (English) ##plugins.themes.ojsPlusA.frontend.article.downloaded##: 729 ##plugins.themes.ojsPlusA.frontend.article.times##
##plugins.themes.ojsPlusA.frontend.article.downloadstatastics##
##plugins.block.makeSubmission.linkLabel##
SJR
COPE
