Role of inflammatory biomarkers and liver function tests in differentiating complicated and uncomplicated acute appendicitis

Sangar Abdullah; Kazım Duman; Güney Özkaya; Adnan Gündoğdu

Role of inflammatory biomarkers and liver function tests in differentiating complicated and uncomplicated acute appendicitis

Abstract

Aims: Distinguishing complicated from uncomplicated acute appendicitis before surgery has important implications for surgical planning and patient counseling. This study aims to evaluate and compare the diagnostic value of inflammatory biomarkers and liver function tests in differentiating complicated from uncomplicated acute appendicitis, and to determine whether their combined use improves predictive performance over inflammatory markers alone. Methods: A total of 722 appendectomy patients from a single institution were retrospectively analyzed. Based on operative findings and histopathological reports, patients were classified as complicated (gangrenous, perforated, abscess) or uncomplicated. Preoperative white blood cell count (WBC), neutrophil, lymphocyte, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were analyzed. Diagnostic performance was evaluated using ROC analysis, logistic regression, and DeLong test model comparison. Results: Of 722 patients, 637 (88.2%) had uncomplicated and 85 (11.8%) had complicated appendicitis. CRP (p<0.001), NLR (p=0.004), and direct bilirubin (p=0.009) differed significantly between groups. Among individual parameters, CRP showed the highest AUC (0.638) and was the only independent predictor in multivariate analysis (OR: 1.007; p<0.001). The inflammatory markers model (AUC: 0.684) significantly outperformed the liver function tests model (AUC: 0.553; p=0.001). Adding liver function tests to inflammatory markers did not improve prediction (p=0.959). Conclusion: CRP was the strongest and most robust independent predictor of complicated appendicitis. Liver function tests did not improve prediction when added to inflammatory markers. Its modest discriminatory ability suggests CRP should support rather than replace clinical evaluation.

Keywords

Supporting Institution

This study received no financial support.

Ethical Statement

This study was approved by the Clinical Research Ethics Committee (Date: 08.05.2026, Decision No: E-46059653-050.04-314200413).

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Details

Primary Language

English

Subjects

General Surgery

Journal Section

Research Article

Authors

Sangar Abdullah ^*
0009-0009-8046-8490
Türkiye

Kazım Duman
0000-0002-5064-5427
Türkiye

Güney Özkaya
0000-0003-0101-7368
Türkiye

Adnan Gündoğdu
0000-0003-2341-3572
Türkiye

Publication Date

July 16, 2026

Submission Date

June 6, 2026

Acceptance Date

July 2, 2026

Published in Issue

Year 2026 Volume: 8 Number: 4

IZ

https://izlik.org/JA67KY54AC

Cite

RIS / Bibtex

APA

Abdullah, S., Duman, K., Özkaya, G., & Gündoğdu, A. (2026). Role of inflammatory biomarkers and liver function tests in differentiating complicated and uncomplicated acute appendicitis. Anatolian Current Medical Journal, 8(4), 759-765. https://izlik.org/JA67KY54AC

AMA

1.Abdullah S, Duman K, Özkaya G, Gündoğdu A. Role of inflammatory biomarkers and liver function tests in differentiating complicated and uncomplicated acute appendicitis. Anatolian Curr Med J / ACMJ / acmj. 2026;8(4):759-765. https://izlik.org/JA67KY54AC

Chicago

Abdullah, Sangar, Kazım Duman, Güney Özkaya, and Adnan Gündoğdu. 2026. “Role of Inflammatory Biomarkers and Liver Function Tests in Differentiating Complicated and Uncomplicated Acute Appendicitis”. Anatolian Current Medical Journal 8 (4): 759-65. https://izlik.org/JA67KY54AC.

EndNote

Abdullah S, Duman K, Özkaya G, Gündoğdu A (July 1, 2026) Role of inflammatory biomarkers and liver function tests in differentiating complicated and uncomplicated acute appendicitis. Anatolian Current Medical Journal 8 4 759–765.

IEEE

[1]S. Abdullah, K. Duman, G. Özkaya, and A. Gündoğdu, “Role of inflammatory biomarkers and liver function tests in differentiating complicated and uncomplicated acute appendicitis”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 4, pp. 759–765, July 2026, [Online]. Available: https://izlik.org/JA67KY54AC

ISNAD

Abdullah, Sangar - Duman, Kazım - Özkaya, Güney - Gündoğdu, Adnan. “Role of Inflammatory Biomarkers and Liver Function Tests in Differentiating Complicated and Uncomplicated Acute Appendicitis”. Anatolian Current Medical Journal 8/4 (July 1, 2026): 759-765. https://izlik.org/JA67KY54AC.

JAMA

1.Abdullah S, Duman K, Özkaya G, Gündoğdu A. Role of inflammatory biomarkers and liver function tests in differentiating complicated and uncomplicated acute appendicitis. Anatolian Curr Med J / ACMJ / acmj. 2026;8:759–765.

MLA

Abdullah, Sangar, et al. “Role of Inflammatory Biomarkers and Liver Function Tests in Differentiating Complicated and Uncomplicated Acute Appendicitis”. Anatolian Current Medical Journal, vol. 8, no. 4, July 2026, pp. 759-65, https://izlik.org/JA67KY54AC.

Vancouver

1.Sangar Abdullah, Kazım Duman, Güney Özkaya, Adnan Gündoğdu. Role of inflammatory biomarkers and liver function tests in differentiating complicated and uncomplicated acute appendicitis. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 Jul. 1;8(4):759-65. Available from: https://izlik.org/JA67KY54AC