Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis

Öz

Aim: The aim of the present study was to investigate the efficacy of simple laboratory parameters including neutrophil-to-lymphocyte ratio (NLR), leukocyte count (WCC), C-reactive protein (CRP)  and red cell distribution width (RDW) values in both diagnosing simple appendicitis and predicting complicated appendicitis.

Material and Methods: A database of 413 patients who underwent surgery was appreciated. Based on postoperative histopathological examination, the patients were divided into two groups: negative appendectomy (G1) and positive appendectomy (G2). Patients in the positive appendectomy group were further divided into two subgroups: simple appendicitis (G2a) and complicated (gangrenous and perforated) appendicitis (G2b).

Results: WCC and NLR were significant parameters for the diagnosis of acute appendicitis. Cut-off values were 11950/mm³ for WCC (sensitivity: 71.7%; specificity: 50%; OR: 2.53) and 3.7 for NLR (sensitivity: 75.1%; specificity: 42.8%; OR:2.25). WCC, CRP and NLR were independent variables for the diagnosis of complicated appendicitis. Cut-off values were 14450/mm³ for WCC (sensitivity: 66.7%; specificity: 59%; OR: 2.87), 25.5 mg/dl for CRP (sensitivity: 63.8%; specificity: 58.2%; OR: 2.47) and 6.94 for NLR (sensitivity: 61.1%; specificity: 61%; OR: 2.51).

Conclusion:  As a result, preoperative NLR is a useful parameter to aid in the diagnosis of acute appendicitis and differentiate between simple and complicated appendicitis and can be used as an adjunct to the clinical examination.

Anahtar Kelimeler

• Appendicitis,neutrophil-to-lymphocyte ratio,laboratory parameters

Basit ve perfore akut apandisit için temel laboratuvar parametrelerinin tanısal değeri

Öz

Amaç: Bu çalışmanın amacı  nötrofil-lenfosit oranı (NLR), lökosit sayısı (WCC), C-reaktif protein (CRP) ve kırmızı kan hücre dağılım genişliği (RDW) gibi değerleri içeren basit laboratuar parametrelerinin basit apandisit ve komplike apandisit tanısı koyma etkinliğini araştırmaktı.

Gereç ve Yöntemler: Ameliyat edilen 413 hastanın postoperatif histopatolojik incelemesine göre  hastalar negatif apendektomi (G1) ve pozitif apendektomi (G2) olmak üzere iki gruba ayrıldı. Pozitif apendektomi grubundaki hastalar, basit apandisit (G2a) ve komplike (gangrenöz ve perfore) apandisit (G2b) olmak üzere iki alt gruba ayrıldı.

Bulgular: WCC ve NLR akut apandisit tanısında önemli parametrelerdir. Cut-off değerleri WCC için 11950 / mm³ (duyarlılık:% 71.7, özgüllük:% 50; OR: 2.53) ve NLR için 3.7 (duyarlılık:% 75.1, özgüllük:% 42.8; OR: 2.25) bulundu. WCC, CRP ve NLR komplike apandisit tanısında bağımsız değişkenlerdi. Cut-off değerleri WCC için 14450 / mm³ (duyarlılık:% 66.7, özgüllük:% 59; OR: 2.87), CRP için 25.5 mg / dl (duyarlılık:% 63.8; özgüllük:% 58.2; OR: 2.47) ve 6.94 NLR (duyarlılık:% 61.1, özgüllük:% 61; OR: 2.51).

Sonuç: Sonuç olarak preoperatif NLR, akut apandisit tanısında, basit ve komplike apandisitleri ayırt etmede yararlı bir parametredir ve klinik muayene için  yardımcı olarak kullanılabilir.

Anahtar Kelimeler

• Apandisit,nötrofil-lenfosit oranı,laboratuvar

Kaynakça

1. 1. Storm Dickerson TL, Horattas MC. What have we learned over the past 20 years about appendicitis in the elderly?. Am J Surg 2003; 185: 198-201.
2. 2. Franz MG, Norman J, Fabri PJ. Increased morbidity of appendicitis with advancing age. Am Surg 1995; 61: 40-44.
3. 3. Freund HR, Rubinstein E. Appendicitis in the aged. Is it really different?. Am Surg 1984; 50: 573-76.
4. 4. Moraitis D, Kini S, Annamaneni R, Zitsman J. Laparoscopy in complicated pediatric appendicitis. JSLS 2004; 8: 310-13.
5. 5. Yokoyama S, Takifuji K, Hotta T et al. C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study. World J Emerg Surg 2009; 4: 36.
6. 6. Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Role of leukocyte count, neutrophil percentage, and C-reactive protein in the diagnosis of acute appendicitis in the elderly. Am Surg 2005; 71: 344-47.
7. 7. Sand M, Trullen XV, Bechara FG et al. A prospective bicenter study investigating the diagnostic value of procalcitonin in patients with acute appendicitis. Eur Surg Res 2009; 43: 291-97.
8. 8. Mentes O, Eryilmaz M, Harlak A et al. Can D-dimer become a new diagnostic parameter for acute appendicitis?. Am J Emerg Med 2009; 27: 765-69.

9. 9. Şahbaz NA, Bat O, Kaya B et al. The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis. TJTES 2014; 20: 423–26.
10. 10. Kamran H, Naveed D, Asad S, Hameed M, Khan U. Evaluation of modified Alvarado score for frequency of negative appendicectomies. J Ayub Med Coll Abbottabad 2010; 22: 46-49.
11. 11. Bozbay M, Uyarel H. Neutrophil-to-lymphocyte ratio: A novel and simple prognostic marker for infective endocarditis. J Crit Care 2015; 30: 822.
12. 12. Graziosi L, Marino E, De Angelis V, Rebonato A, Cavazzoni E, Donini A. Prognostic value of preoperative neutrophils to lymphocytes ratio in patients resected for gastric cancer. Am J Surg 2015; 209: 333-37.
13. 13. Seretis C, Gourgiotis S, Gemenetzis G, Seretis F, Lagoudianakis E, Dimitrakopoulos G. The significance of neutrophil/lymphocyte ratio as a possible marker of underlying papillary microcarcinomas in thyroidal goiters: a pilot study. Am J Surg 2013; 205: 691–96.
14. 14. Chen J, Deng Q, Pan Y et al. Prognostic value of neutrophil‐to‐lymphocyte ratio in breast cancer. FEBS Open Bio 2015; 5: 502-07.
15. 15. Paramanathan A, Saxena A, Morris DL. A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours. Surg Oncol 2014; 23: 31-39.
16. 16. Yavuz E, Erçetin C, Uysal E et al. Diagnostic Value Of Neutrophil/Lymphocyte Ratio In Geriatric Cases With Appendicitis. Turk J Geriatr 2014; 17 : 345-49.
17. 17. 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: 84-89.
18. 18. Kahramanca Ş, Özgehan G, Şeker D et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis TJTES 2014; 20: 19-22.
19. 19. 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.
20. 20. Markar S, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg 2010; 110: 543-47.
21. 21. Seetahal SA, Bolorunduro OB, Sookdeo TC et al. Negative appendectomy: a 10-year review of a nationally representative sample. Am J Surg 2011; 201: 433-37.
22. 22. Talan DA, Saltzman DJ, Mower WR et al. Antibiotics-first versus surgery for appendicitis: a US pilot randomized controlled trial allowing outpatient antibiotic management. Ann Emerg Med 2017; 70: 1-11.
23. 23. Tecer D, Sezgin M, Kanık A et al. Can mean platelet volume and red blood cell distribution width show disease activity in rheumatoid arthritis? Biomark Med 2016; 10: 967-74.
24. 24. Akkermans MD, Vreugdenhil M, Hendriks DM et al. Iron deficiency in inflammatory bowel disease: the use of zincprotoporphyrin and red blood cell distribution width. J Pediatr Gastroenterol Nutr 2017; 64: 949-54.
25. 25. Ay S, Eryilmaz MA, Aksoy N, Okus A, Unlu Y, Sevinc B. Is early detection of colon cancer possible with red blood cell distribution width. Asian Pac J Cancer Prev 2015; 16: 753-56.
26. 26. Harmanci O, Kav T, Sivri B. Red cell distribution width can predict intestinal atrophy in selected patients with celiac disease. J Clin Lab Anal 2012; 26: 497-502.
27. 27. Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Laboratory tests in patients with acute appendicitis. ANZ J Surg 2006; 76: 71-74.
28. 28. Asfar S, Safar H, Khoursheed M, Dashti H, Al-Bader A. Would measurement of C-reactive protein reduce the rate of negative exploration for acute appendicitis? J R Coll Surg Edinb 2000; 45: 21-24.
29. 29. Ertekin B, Hasan K, Erdemir E, Doğan E, Acar T, Demir LS. Efficacy of Use of Red Cell Distribution Width as a Diagnostic Marker in Acute Appendicitis. Eurasian J Emerg Med 2017; 16: 29-33.
30. 30. Hallan S, Asberg A. The accuracy of C-reactive protein in diagnosing acute appendicitis—a meta-analysis. Scand J Clin Lab Invest 1997; 57: 373-80.
31. 31. Barreto SG, Travers E, Thomas T et al. Acute perforated appendicitis: An analysis of risk factors to guide surgical decision making Indian J Med Sci 2010; 64: 58-65.