Predictive Role of Hematological Markers on Pediatric Appendicitis: Still a Mystery

Abstract

Aim: The diagnosis of appendicitis may be challenging in the pediatric population. It can be very difficult to examine a child or to take a medical history. The role of laboratory findings is still unclear. Therefore, we aimed to evaluate the diagnostic value of hematological parameters such as white blood cell, neutrophil to eosinophil ratio, and neutrophil to lymphocyte ratio. Material and Methods: We retrospectively analyzed patients who underwent surgery with suspected appendicitis between February 2018 and February 2020. Preoperative data were gathered from patient records. Histopathological assessment was accepted as the gold standard in the diagnosis of appendicitis. Results: The study population consists of 368 patients with a mean age of 11.95±3.68 years, 56.25% (n=207) of whom were male. The pathological examination revealed that 63.6% (n=234) of the patients were acute appendicitis, 18.5% (n=68) phlegmonous, and 8.7% (n=32) perforated. White blood cells, neutrophil-eosinophil ratio, and neutrophil-lymphocyte ratio were not diagnostic in acute appendicitis. On the other hand, the same parameters are useful markers in differentiating phlegmonous and perforated appendicitis. Conclusion: There is no established biomarker for acute appendicitis. Although the white blood cell count is a well-known parameter in scoring systems, it is not capable of guiding the surgeon. The neutrophil to eosinophil ratio may be a novel diagnostic index for phlegmonous and perforated appendicitis. Understanding whether a child is experiencing appendicitis is still a diagnostic challenge for the clinician. Although clinical symptoms, scoring systems, and imaging methods and laboratory tests are important in the diagnosis of appendicitis, there are not any specific markers helping the surgeon.

Keywords

• Appendicitis
• neutrophil to eosinophil ratio
• White blood cell
• neutrophil to lymphocyte ratio
• Pediatric Surgery

Hematolojik Belirteçlerin Pediatrik Apandisitte Tanısal Rolü: Gizemini Koruyor

Abstract

Amaç: Apandisit tanısı pediyatrik popülasyonda zor olabilir. Çocukları muayene etmek veya hikaye almak oldukça zor olabilmektedir. Laboratuvar bulgularının rolü hala belirsizdir. Bu nedenle beyaz kan hücresi, nötrofil / eozinofil oranı ve nötrofil / lenfosit oranı gibi hematolojik parametrelerin tanısal değerinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Şubat 2018 ile Şubat 2020 arasında apandisit şüphesiyle ameliyat edilen hastalar retrospektif olarak incelendi. Ameliyat öncesi veriler hasta kayıtlarından toplandı. Apandisit tanısında histopatolojik değerlendirme altın standart olarak kabul edildi. Bulgular: Çalışma popülasyonu, yaş ortalaması 11,95±3,68 yıl idi, % 56,25'i (n=207) erkek olmak üzere 368 hastadan oluşmaktadır. Patolojik inceleme hastaların % 63,6'sının (n=234) akut apandisit,% 18,5'inin (n=68) flegmonöz ve % 8,7'sinin (n=32) perfore olduğunu ortaya koydu. Akut apandisitte beyaz kan hücreleri, nötrofil-eozinofil oranı ve nötrofil-lenfosit oranı tanısal değildi. Öte yandan, aynı parametreler flegmonöz ve perfore apandisiti ayırt etmede yararlı belirteçlerdir. Sonuç: Akut apandisit için spesifik bir biyobelirteç yoktur. Beyaz kan hücresi sayısı skorlama sistemlerinde iyi bilinen bir parametre olmasına rağmen, cerraha yol gösterme kabiliyetine sahip değildir. Nötrofil / eozinofil oranı, flegmonöz ve perfore apandisit için yeni bir tanı indeksi olabilir. Bir çocuğun apandisit olup olmadığını anlamak bazen cerrahları zorlamaktadır. Klinik semptomlar, skorlama sistemleri, görüntüleme yöntemleri ve laboratuvar yardımcı olsa da cerraha tanı koyduracak spesifik bir yöntem veya marker bulunmamaktadır.

Keywords

• Apandisit
• nötrofil-eozinofil oranı
• beyaz küre
• nötrofil-lenfosit oranı
• çocuk cerrahi

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