Use of platelet large cell ratio as a new biomarker in the diagnosis of acute appendicitis

Year 2020, , 479 - 482, 01.06.2020

Muhammet Celik Erdal Tekin , Mustafa Bayraktar

https://doi.org/10.28982/josam.690517

Cited By: 1

Abstract

Aim: Acute appendicitis (AA) is one of the common causes of acute abdomen. Despite classical signs and symptoms, it may not always be easily and quickly diagnosed. Although many laboratory and imaging methods and risk scoring systems are available, studies are currently underway to find new biomarkers. In this study, we aimed to investigate whether Platelet-Large Cell Ratio (P-LCR), one of the platelet parameters, can be used as a new biomarker.
Methods: This retrospective cross-sectional study was performed by scanning the hospital records of AA patients, as determined with histopathological examination, who were diagnosed between 01 January-November 2019. The patients were divided into three as normal appendectomy (Group 1), non-complicated appendicitis (Group 2) and complicated appendicitis (Group 3) groups, which were compared in terms of P-LCR and other platelet parameters.
Results: A total of 425 patients were included in the study. The number of female patients in Groups 1, 2 and 3 were 12 (36.4%), 42 (45.7%), and 121 (40.3%), respectively. The mean age of the patients was 27.2 (16.1) years. Among all, complicated and uncomplicated appendectomy groups had significantly higher WBC and lower PDW and P-LCR values compared to the normal appendectomy group (P=0.007, P=0.027 and P=0.036, respectively). The cut-off values of WBC and P-LCR were 11.47 (71.9% sensitivity, 51.5% specificity) and 19.85 (75.8% sensitivity, 32.4% specificity), respectively. The WBC and P-LCR values had strong distinguishing features compared to other parameters (AUC=0.630, P=0.013 and AUC=0.604, P=0.047, respectively).
Conclusion: This is the first study investigating the P-LCR value in the diagnosis of AA. We found that WBC, PDW and P-LCR values, which are whole blood count parameters, can be used in the diagnosis of AA.

Keywords

Acute appendicitis, Platelet large cell ratio, Platelet count, Mean platelet volume, Platelet distribution volume

Supporting Institution

No

Project Number

B.30.2.ATA.0.01.00/489

Akut apandisit tanısında yeni bir biyobelirteç olarak trombosit büyük hücre oranının kullanımı

Abstract

Amaç: Akut apandisit, akut karnın yaygın nedenlerinden biridir. Klasik belirti ve semptomlara rağmen, her zaman kolay ve hızlı bir şekilde teşhis edilemeyebilir. Birçok laboratuvar ve görüntüleme yöntemi ve risk skorlama sistemi mevcut olmasına rağmen, yeni biyobelirteçleri bulmak için çalışmalar devam etmektedir. Bu çalışmada trombosit parametrelerinden biri olan Trombosit-Büyük Hücre Oranının (P-LCR) yeni bir biyobelirteç olarak kullanılıp kullanılamayacağını araştırmayı amaçladık.
Yöntem: Çalışma, retrospektif tanımlayıcı bir çalışma olarak planlanarak, 01 Ocak 2019 ve Kasım 2019 tarihleri arasında gerçekleştirildi. Akut apandisit tanılı hastaların kayıtları tarandı. Hastalar histopatolojik sonuçlarına göre normal apendektomili, non-komplike apandisitli ve komplike apandisitli olmak üzere üç gruba ayrıldı. Gruplar P-LCR ve diğer trombosit parametreleri açısından karşılaştırıldı.
Bulgular: Toplam 425 hasta çalışmaya dâhil edildi. Gruplardaki kadın hasta sayıları sırasıyla 12 (%36,4), 42 (%45,7) ve 121 (%40,3) idi. Hastaların yaş ortalaması 27,2 (16,1) idi. Komplike ve komplike olmayan apendektomi grupları, normal apendektomi grubu ile karşılaştırıldığında, anlamlı derecede yüksek WBC düzeyleri ve düşük PDW ve P-LCR değerleri saptandı ( P=0,007; P=0,027 ve P=0,036). WBC sayısı eğri altındaki alan (AUC) 0,63 idi ve diğer parametrelere göre güçlü ayırt edici özelliğe sahip idi ( P=0,013). WBC’nin cut-off değeri 11,47 alındığında sensitivitesi %71,9, spesifisitesi %51,5 bulundu. P-LCR’nin cut-off değeri 19,85 alındığında ise sensitivitesi %67,6, spesifisitesi %32,4 idi (AUC=0,396; P=0,047).
Sonuç: P-LCR'nin akut apandisit tanısında kullanılabilirliği ile ilgili yapılan bu ilk çalışmada, tam kan sayımı parametreleri olan WBC, PDW ve P-LCR değerlerinin akut apandisit tanısında kullanılabileceği bulunmuştur.

Keywords

Akut apandisit, Trombosit büyük hücre oranı, Trombosit sayısı, Ortalama trombosit hacmi, Trombosit dağılım hacmi

Project Number

B.30.2.ATA.0.01.00/489

References

• 1. Yigit Y, Yilmaz S, Ozbek AE, Karakayali O, Cetin B, Halhalli HC. Can Platelet Indices Reduce Negative Appendectomy Rates? Cureus. 2019;11(3):e4293-e.
• 2. Sepas HN, Negahi A, Mousavie SH, Nasiri M. Evaluation of the Potential Association of Platelet Levels, Mean Platelet Volume and Platelet Distribution Width with Acute Appendicitis. Open Access Maced J Med Sci. 2019;7(14):2271-6.
• 3. Gwynn LK. The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. The Journal of emergency medicine. 2001;21(2):119-23.
• 4. Stringer MD. Acute appendicitis. Journal of Paediatrics and Child Health. 2017;53(11):1071-6.
• 5. Teo AT, Lefter LP, Zarrouk AJ, Merrett ND. Institutional review of patients presenting with suspected appendicitis. ANZ Journal of Surgery. 2015;85(6):420-4.
• 6. Bhangu A, Soreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet (London, England). 2015;386(10000):1278-87.
• 7. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Annals of Emergency Medicine. 1986;15(5):557-64.
• 8. Niton T, Gorecka-Niton A. Review of diagnostic scoring systems in acute appendicitis. Wiad Lek. 2014;67(1):45-51.
• 9. Boshnak N, Boshnaq M, Elgohary H. Evaluation of Platelet Indices and Red Cell Distribution Width as New Biomarkers for the Diagnosis of Acute Appendicitis. Journal of Investigative Surgery. 2018;31(2):121-9.
• 10. Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. Western Journal of Emergency Medicine. 2014;15(7):859.
• 11. Markar S, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chirurgica Belgica. 2010;110(5):543-7.
• 12. Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, et al. The global incidence of appendicitis: a systematic review of population-based studies. Annals of Surgery. 2017;266(2):237-41.
• 13. Qi F-Q, Zhang B. Clinical significance of C-reactive protein levels in the determination of pathological type of acute appendicitis. International Journal of Clinical and Experimental Medicine. 2015;8(8):13887.
• 14. Atema JJ, Gans SL, Beenen LF, Toorenvliet BR, Laurell H, Stoker J, et al. Accuracy of White Blood Cell Count and C-reactive Protein Levels Related to Duration of Symptoms in Patients Suspected of Acute Appendicitis. Academic Emergency Medicine. 2015;22(9):1015-24.
• 15. Mehrabi A, Golriz M, Khajeh E, Ghamarnejad O, Probst P, Fonouni H, et al. Meta-analysis of the prognostic role of perioperative platelet count in posthepatectomy liver failure and mortality. The British Journal of Surgery. 2018;105(10):1254-61.
• 16. Fan Z, Zhang Y, Pan J, Wang S. Acute Appendicitis and Mean Platelet Volume: A Systemic Review and Meta-analysis. Ann Clin Lab Sci. 2017;47(6):768-72.
• 17. Doherty GM. Current diagnosis & treatment: surgery: Lange Medical Books/McGraw-Hill; 2010.
• 18. Biricik S, Narcı H, Dündar GA, Ayrık C, Türkmenoğlu MÖ. Mean platelet volume and the ratio of mean platelet volume to platelet count in the diagnosis of acute appendicitis. The American Journal of Emergency Medicine. 2019;37(3):411-4.
• 19. Thachil J. Platelets in Inflammatory Disorders: A Pathophysiological and Clinical Perspective. Seminars in Thrombosis and Hemostasis. 2015;41(6):572-81.
• 20. Gunes ME, Deniz MM, Yilmaz S. Diagnostic value of platelet indices in acute appendicitis and comparison with histopathology. Annali Italiani di Chirurgia. 2017;88:222-8.
• 21. Verdoia M, Barbieri L, Schaffer A, Cassetti E, Marino P, Bellomo G, et al. Platelet–larger cell ratio and the risk of periprocedural myocardial infarction after percutaneous coronary revascularization. Heart and Vessels. 2015;30(1):20-7.
• 22. Levent C, Zeynep C. Relationship between coronary tortuosity and plateletcrit coronary tortuosity and plateletcrit. Cardiovascular Journal of Africa. 2017;28(6):385.
• 23. De Luca G, Santagostino M, Secco GG, Cassetti E, Giuliani L, Coppo L, et al. Platelet-large cell ratio and the extent of coronary artery disease: results from a large prospective study. Journal of Thrombosis and Thrombolysis. 2010;30(4):426-33.