The accuracy of white cell count and C-reactive protein in diagnosing acute appendicitis at a tertiary hospital.

BACKGROUND: Diagnostic accuracy in acute appendicitis (AA) may be improved by using inflammatory markers. This study assessed the reliability of inflammatory markers in diagnosing AA in our patient population. METHODS: A retrospective cross-sectional study was conducted at King Edward Hospital (KEH) from January 2020 to June 2021. Data was collected on all patients with AA who underwent appendicectomy. Variables of age, gender, comorbidities, HIV status Alvarado score histology, C-reactive protein (CRP), and white cell count (WCC) were reviewed. A p-value of < 0.05 is deemed as statistically significant. RESULTS: The study cohort was comprised of 150 patients - 58(39%) females and 92(61%) males. Thirty-two (21.3%) patients had a normal appendix, of whom 19 had a normal WCC. The majority of patients 80 (53.3%) had inflamed appendix, and 38 (25.3%) had ruptured appendix. The sensitivity and specificity of WCC and the CRP were 81% and 46% and 100% and 18.6% respectively. No patient with a ruptured appendix had normal CRP. The CRP correlated with the ruptured appendix with a median of 141.5 and, p-value of 0.01. The level of WCC and the presence of a ruptured appendix had a significant correlation with a p-value of 0.002, median of 15.2. CONCLUSION: A combination of WCC and CRP tests improves the diagnostic accuracy. There is a correlation between CRP level and ruptured appendicitis. In our setting, AA is likely to present late once it has already ruptured. The reasons behind this late presentation need to be explored and addressed.

Predictive model for identification of gangrenous or perforated appendicitis in adults: a multicenter retrospective study.

BACKGROUND: Gangrene and perforation are severe complications of acute appendicitis, associated with a higher mortality rate compared to uncomplicated appendicitis. Accurate preoperative identification of Gangrenous or perforated appendicitis (GPA) is crucial for timely surgical intervention. METHODS: This retrospective multicenter study includes 796 patients who underwent appendectomy. Univariate and multivariate logistic regression analyses are used to develop a nomogram model for predicting GPA based on laboratory tests and computed tomography (CT) findings. The model is validated using an external dataset. RESULTS: Seven independent predictors were included in the nomogram: white blood cell count, lymphocyte count, D-dimer, serum glucose, albumin, maximum outer diameter of the appendix, and presence of appendiceal fecalith. The nomogram achieved good discrimination and calibration in both the training and testing sets. In the training set, the AUC was 0.806 (95%CI: 0.763-0.849), and the sensitivity and specificity were 82.1% and 66.9%, respectively. The Hosmer-Lemeshow test showed good calibration (P = 0.7378). In the testing set, the AUC was 0.799 (95%CI: 0.741-0.856), and the sensitivity and specificity were 70.5% and 75.3%, respectively. Decision curve analysis (DCA) confirmed the clinical utility of the nomogram. CONCLUSION: The laboratory test-CT nomogram model can effectively identify GPA patients, aiding in surgical decision-making and improving patient outcomes.

5-Hydroxyindoleacetic acid as a biomarker for revealing perforation in acute appendicitis.

BACKGROUND: The present study investigated the level of 5-hydroxyindoleacetic acid (5-HIAA) in perforated and nonperforated appendicitis patients. This issue is important for timely diagnosis of acute appendicitis complications and making decision about the surgical plan and type of incision. METHODS: This prospective study was conducted on patients with acute appendicitis. 5-HIAA levels were measured in urine spot sample of every patient before the surgery. The patients were finally included based on result of pathology for presence of appendicitis or not and sorted by direct surgical detection for exist of perforation or not. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 5-HIAA were investigated. The data were statistically analyzed by SPSS v.27. RESULTS: A total of 150 patients were included in two groups as 40 patients in the perforated appendicitis group and 110 patients in the noncomplicated acute appendicitis group. The average age of patients in the perforated appendicitis group was 28.8 ± 6.07 years, and that of patients in the acute appendicitis group was 29.6 ± 6.96 years. 94 patients (63%) were male, and 56 (37%) were female. No significant difference was observed in terms of age or sex between the two groups. The difference in the 5-HIAA concentration between the acute appendicitis group (0.3 ± 0.04 mg/dl) and the perforated appendicitis group (0.5 ± 0.03 mg/dl) was significant (P < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 82%, 62%, 75%, 77%, and 88% respectively. CONCLUSION: This study shows that the 5-HIAA concentration in patients with perforated appendicitis can potentially increased significantly more than that in patients in the early stages of acute appendicitis. further studies with larger sample sizes are needed to prove the present results.

Hyponatremia as a predictor of complicated appendicitis: a systematic review and meta-analysis.

Aim: To investigate the value of hyponatremia as a predictive marker for complicated appendicitis.Methods: PubMed, Embase, Web of Science and Scopus databases were searched for studies published up to 5 June 2024. Studies reporting serum sodium levels in patients with complicated and non-complicated appendicitis and studies reporting the association between baseline hyponatremia and complicated appendicitis were included. A random-effects meta-analysis was performed.Results: Twenty-two studies met the eligibility criteria. Serum sodium levels were measured at arrival or preoperatively in all included studies. Meta-analysis of data from 17 studies showed that preoperative sodium levels were significantly lower in patients with complicated appendicitis vs uncomplicated appendicitis [Mean Difference (MD): -2.58 95% confidence intervals (CI): -3.51, -1.66 I2 = 98%]. A pooled analysis of 18 studies demonstrated a statistically significant association between preoperative hyponatremia and complicated appendicitis [Odds Ratio (OR): 4.11 95% CI: 3.07, 5.51 I2 = 93%]. Results remained significant on subgroup analysis for adult and pediatric populations. However, the MD was higher and the OR was higher in the subgroup of pediatric patients.Conclusion: Hyponatremia was identified as a potential predictor for complicated appendicitis. The association between hyponatremia and complicated appendicitis seems to be stronger in pediatric patients as compared with adults.

[Box: see text].

[Factors associated with normal leukocyte count and C-reactive protein in adults with acute appendicitis: a retrospective cohort study]. / Faktory, svyazannye s normal'nym kolichestvom leikotsitov i urovnem S-reaktivnogo belka u vzroslykh bol'nykh s ostrym appenditsitom: retrospektivnoe kogortnoe issledovanie.

OBJECTIVE: To identify the factors associated with normal leukocyte count and C-reactive protein (CRP) in adults with acute appendicitis. MATERIAL AND METHODS: A retrospective cohort study included patients aged 18-60 years after surgeries for acute appendicitis. Convenience sampling was used to select medical records, and variables such as age, sex, weight, height, origin, self-medication, diabetes (DM2), high blood pressure (HBP), type of appendicitis, duration of illness, preoperative time, type of appendectomy, operative time, and hospital stay were analyzed. Patients were categorized into those with normal and abnormal inflammatory parameters. The SPSS version 28 software was used for analysis. RESULTS: We included 333 patients; 11.11% ones had normal inflammatory parameters. Both groups had mean age of approximately 33 years. Men comprised 56.76% and 57.43%in both groups, respectively. The abnormal group had shorter mean preoperative time, and catarrhal appendicitis was more common in the normal group. Multivariate analysis revealed that rural origin and self-medication were significantly associated with normal inflammatory parameters. CONCLUSION: The prevalence of normal inflammatory parameters in acute appendicitis patients was 11.11%. Rural origin, self-medication, shorter preoperative time, and catarrhal appendicitis were significantly associated with normal inflammatory parameters in this context.

Risk factors for acute complicated appendicitis in children aged three years and younger.

OBJECTIVE: The aim of this study is to identify risk factors associated with acute complicated appendicitis (CA) in children aged three years or younger, providing a theoretical foundation for the management and treatment of acute appendicitis (AA). METHODS: A retrospective analysis was conducted on 135 pediatric patients with AA, admitted to the Department of General Surgery at Anhui Children's Hospital between December 2020 and December 2023, who underwent successful surgical treatment. Based on the intraoperative and postoperative pathological findings, patients were categorized into two groups: complicated appendicitis (CA) (n = 97 cases) and uncomplicated appendicitis (UA) (n = 38 cases). Clinical data including gender, age, weight, disease duration, preoperative white blood cell count (WCC), neutrophil granulocyte (NEUT) count, C-reactive protein (CRP) levels, total bilirubin (TBil) levels, procalcitonin (PCT) levels, calprotectin (Cal) levels, preoperative ultrasound results indicating the presence or absence of fecaliths, maximum appendix diameter, and pediatric appendicitis sore (PAS) were collected and analyzed. Comparative analysis was performed to investigate the differences between the groups and identify risk factors of CA. RESULTS: The CA group exhibited significantly higher values in disease duration, CRP levels, PCT, Cal, presence of appendiceal fecaliths, maximum appendix diameter, and PAS compared to the UA group (P < 0.05). Multivariate analysis identified CRP levels, maximum appendix diameter, and PAS as independent risk factors for CA. Specifically, differences in CRP level (OR = 1.045, 95% CI:1.024 ~ 1.067, P < 0.001), PAS (OR = 1.768, 95% CI:1.086 ~ 2.879, P = 0.022), and maximum appendix diameter (OR = 1.860, 95% CI:1.085 ~ 3.191, P = 0.024) were significant. The area under the receiver operating characteristic curve values were 0.6776 for the PAS, 0.7663 for CRP, and 0.5604 for the maximum appendix diameter. CONCLUSION: CRP levels, PAS, and maximum appendix diameter are independent risk factors for CA in children under three years of age. These parameters are valuable for the early diagnosis of CA.

Assessment of Alvarado criteria, ultrasound, CRP, and their combination in patients with suspected acute appendicitis: a single centre study.

BACKGROUND: Acute appendicitis (AA) is one of the most common reasons for visiting the emergency room. The lack of proper diagnosis and rapid treatment of AA may lead to severe complications such as intestinal perforation and increased mortality. This study aimed to evaluate the diagnostic accuracy of the Alvarado criteria, ultrasound, and CRP criteria in comparison with their combined use in patients with suspected AA who presented to the emergency room. METHODS: In this diagnostic accuracy study, 1411 patients with suspected AA who presented to the emergency department of Firoozabadi Hospital affiliated with Iran University of Medical Sciences and underwent appendectomy from October 2019 to October 2021 were examined. Nine hundred eighty-eight patients were enrolled. All patients were assessed using Alvarado, CRP, and ultrasound. The definitive diagnosis of AA was based on pathological findings and was considered the gold standard. Statistical analyses were performed with STATA VER 11.5. The diagnostic accuracy for each group was compared using the Pearson chi-square test. A value of p < 0.05 was considered statistically significant. RESULTS: The mean age was 29.57 ± 13.66 years. The sensitivity and specificity of Alvarado in the diagnostic accuracy of appendicectomy were 75.2% and 61.3% (CI = 95%), respectively. The sensitivity of ultrasound and CRP for predicting appendicitis was significantly higher than the Alvarado criteria. The diagnostic accuracy for CRP was significantly higher than ultrasound (64.9% vs. 60.7%, P: 0.003). The diagnostic accuracy of the simultaneous use of Alvarado + CRP and CRP + Ultrasound was significantly higher than that of Alvarado + ultrasound. The sensitivity, specificity, and diagnostic accuracy of the simultaneous use of all three criteria together (Alvarado + Ultrasound + CRP) were estimated to be 94.9%, 25.8%, and 81.5% (CI = 95%), respectively, which were significantly higher than the use of other criteria. CONCLUSION: This study showed that the Alvarado criteria had inadequate diagnostic sensitivity and accuracy for diagnosing acute appendicitis. The diagnostic accuracy of acute appendicitis increases to over 90% using the three Alvarado, ultrasound, and CRP criteria at the same time.

The diagnostic value of serum hepcidin in acute appendicitis.

BACKGROUND: Acute appendicitis (AA) is the primary cause of acute abdomen in patients presenting to the emergency department with abdominal pain. Limited studies have explored the relationship between serum hepcidin levels and AA. This study aimed to measure serum hepcidin levels in patients undergoing surgery with a preliminary diagnosis of AA and to assess whether these levels can serve as a biochemical marker for diagnosing AA. METHODS: This study included patients aged 18 or older who presented to the emergency department between April 2018 and May 2019 and underwent surgery with a diagnosis of AA. The cohort comprised 94 patients with surgical pathology results compatible with AA (Group A), 16 patients with results not compatible with AA (Group B), and 42 healthy controls. Serum hepcidin levels were measured from venous blood samples. RESULTS: Mean hepcidin levels were 1750±285 pg/mL in Group A, 1349±381 pg/mL in Group B, and 1066±225 pg/mL in the control group. Statistically significant differences in serum hepcidin levels were observed between Group A and the control group (p<0.05). CONCLUSION: Hepcidin levels were significantly higher in patients with AA compared to both the control group and patients with surgically confirmed non-AA pathology. Therefore, hepcidin may serve as a useful adjunct in diagnosing acute appendicitis.

Changes in Levels of Serum Cytokines and Chemokines in Perforated Appendicitis in Children.

Appendicitis is primarily diagnosed based on intraoperative or histopathological findings, and few studies have explored pre-operative markers of a perforated appendix. This study aimed to identify systemic biomarkers to predict pediatric appendicitis at various time points. The study group comprised pediatric patients with clinically suspected appendicitis between 2016 and 2019. Pre-surgical serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), intercellular cell-adhesion molecule-1 (ICAM-1), and endothelial selectin (E-selectin) levels were tested from day 1 to day 3 of the disease course. The biomarker values were analyzed and compared between children with normal appendices and appendicitis and those with perforated appendicitis (PA) and non-perforated appendicitis. Among 226 pediatric patients, 106 had non-perforated appendicitis, 102 had PA, and 18 had normal appendices. The levels of all serum proinflammatory biomarkers were elevated in children with acute appendicitis compared with those in children with normal appendices. In addition, the serum IL-6 and TNF-α levels in children with PA were significantly higher, with an elevation in TNF-α levels from days 1 and 2. In addition, serum IL-6 levels increased significantly from days 2 and 3 (both p < 0.05). Serum ICAM-1 and E-selectin levels were elevated in the PA group, with consistently elevated levels within the first three days of admission (all p < 0.05). These results indicate that increased serum levels of proinflammatory biomarkers including IL-6, TNF-α, ICAM-1, and E-selectin could be used as parameters in the prediction and early diagnosis of acute appendicitis, especially in children with PA.

Utility of thiol/disulphide homeostasis as a biomarker for acute appendicitis: a systematic review and meta-analysis.

The aim of this study was to analyze the role of thiol/disulfide homeostasis (TDH) parameters as an indicator of oxidative stress in acute appendicitis (AA). PubMed, EMBASE, Web of Science, and Scopus databases were systematically searched. Studies reporting on TDH in AA (both complicated and uncomplicated cases) were included. The comparator group were healthy controls. The TDH domain was compared between the groups using anti-oxidant parameters, namely native thiol and total thiol levels, and native thiol/total thiol ratio; and oxidant parameters, namely disulfide level, disulfide/native thiol ratio, and disulfide/total thiol ratio. The statistical analysis was performed using a random-effects model. The methodological quality of the studies was assessed utilizing the Newcastle-Ottawa scale. Eleven studies with a total of 926 subjects, comprising 457 patients with uncomplicated appendicitis, 147 with complicated appendicitis, and 322 healthy controls were included. Our study demonstrated significantly increased oxidative stress in AA as compared to healthy controls in all TDH parameters and significantly lower total thiol levels in complicated AA as compared to uncomplicated AA. Due to a poor methodological quality in five out of eleven studies, future prospective studies with adequate power are essential to validate these observations and refine the diagnostic approaches to AA.

The Impact of Protein Glycosylation on the Identification of Patients with Pediatric Appendicitis.

The identification of pediatric appendicitis is challenging due to the lack of specific markers thereby several factors are included in the diagnostic process such as abdominal pain, ultrasonography and altered laboratory parameters (C reactive protein, absolute neutrophil cell number and white blood cell number). The glycosylation pattern of serum N-glycome was analyzed in this study of 38 controls and 40 patients with pediatric appendicitis. The glycans were released by enzymatic deglycosylation followed by fluorescent labeling and solid-phase extraction. The prepared samples were analyzed by hydrophilic interaction liquid chromatography with fluorescence and mass-spectrometric detection. The generated data were analyzed by multiple statistical tests involving the most important laboratory parameters as well. Significant differences associated with the examined patient groups were revealed suggesting the potential use of glycosylation analysis supporting the detection of pediatric appendicitis.

Exploring S100A8/A9, neopterin, and MMP3 in familial Mediterranean fever.

Familial Mediterranean fever (FMF) is characterized by inflammatory attacks due to overactivation of pyrin inflammasome. This study aimed to investigate the reliability of S100A8/A9, neopterin, and matrix metalloproteinase 3 (MMP3) at monitoring subclinical inflammation and disease activity, and at differentiating FMF attacks from appendicitis, the most common misdiagnosis among FMF patients. Blood samples (n = 75), comprising from FMF patients during an attack (n = 20), the same FMF patients during the attack-free period (n = 14), patients with appendicitis (n = 24), and healthy volunteers (n = 17) were obtained. Duplicate determinations of S100A8/A9, neopterin, and MMP-3 levels were conducted using the enzyme-linked immunosorbent assay (ELISA). FMF patients with and without attack and patients with appendicitis had significantly elevated S100A8/A9 levels compared to healthy volunteers (P-values: < 0.001, 0.036, 0.002, respectively). Patients with appendicitis and FMF patients with and without attack had significantly increased serum neopterin levels compared to healthy volunteers (P-value: < 0.001). MMP3 levels were significantly higher among patients with appendicitis and FMF patients during attack compared to healthy controls (P-values: < 0.001, 0.001). Serum levels of S100A8/A9, neopterin, and MMP3 were increased significantly during attacks compared to attack-free periods among FMF patients (P-values: 0.03, 0.047, 0.007). S100A8/A9 emerges as a valuable marker for monitoring disease activity. Neopterin and S100A8/A9 might help physicians to monitor subclinical inflammation during the attack-free periods of FMF patients. MMP3 might aid in diagnosing FMF attacks when distinguishing between attack and attack-free periods is challenging.

The use of C-reactive protein to predict uncomplicated appendicitis and increase uptake of laparoscopy in low resource hospitals-A retrospective cohort study.

BACKGROUND: Acute appendicitis remains the most common surgical emergency worldwide. There has been a low uptake of laparoscopic appendicectomy in the South African public sector. Preoperative identification of cases of uncomplicated appendicitis that are amenable to a laparoscopic approach may facilitate the implementation of laparoscopic appendicectomy programs in training hospitals. With limited access to preoperative imaging, alternative strategies for this preoperative prediction are needed. METHODS: A retrospective audit of patients over the age of 12 years with a histologically confirmed diagnosis of acute appendicitis over a 5-year period was performed. Patients were categorized as uncomplicated or complicated appendicitis and C-reactive protein (CRP) and white cell count (WCC) reviewed. Receiver operating characteristics curves were constructed for these blood tests and acute appendicitis severity. Youden's J statistic was used to determine optimal cut off values for diagnosing complicated appendicitis. RESULTS: 358 patients had confirmed appendicitis and complete blood results. Of these, 189 (52.79%) had complicated appendicitis with a 40.22% perforation rate. Median CRP in uncomplicated and complicated groups were 68 mg/L (IQR 19-142) and 216 mg/L (IQR 103-313) with an area under the curve (AUC) of 0.75 (95% CI: 0.70-0.80). The median WCC in the two groups were 12.6 × 109 cells/L (IQR 9.9-15.6) and 14.4 × 109 cells/L (IQR 11.5-18.28) with an AUC of 0.61 (95% CI: 0.56-0.67). The optimal cut off value for CRP was found to be 110 mg/L with a sensitivity of 74.74% and specificity of 69.23%. CONCLUSION: A cutoff value of 110 mg/dl CRP can distinguish patients with early appendicitis from those with complicated disease and when used in conjunction with clinical assessment may help identify patients in whom laparoscopic appendicectomy is appropriate.

Diagnostic performance of serum CA-125 for overall and complicated acute appendicitis: a systematic review and meta-analysis.

This study aimed to analyze the diagnostic performance of serum CA-125 in acute appendicitis (AA). This review was registered in PROSPERO (CRD42023450988). We included prospective and retrospective original clinical studies evaluating the diagnostic performance of serum CA-125 in AA. A search was conducted in PubMed, Web of Science, Scopus, and OVID. Search terms and keywords were: (appendicitis OR appendectomy) AND (CA-125 OR CA125). Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS-2 index. A synthesis of the results, standardization of the metrics, and three random-effect meta-analyses were performed. Five studies with data from 533 participants (including 219 patients with a confirmed diagnosis of AA and 107 controls) were included in this review. The random-effect meta-analysis of serum CA-125 (AA vs controls) included 3 articles (125 AA and 70 controls) and resulted in a non-significant mean difference [95% CI] of - 6.80 [- 20.51, 6.92] U/mL (p = 0.33). The meta-analysis by subgroups that included only male patients resulted in a significant mean difference [95% CI] of 3.48 [0.46, 6.49] U/mL (p = 0.02). Although serum CA-125 does not appear to be a good overall marker for the diagnosis of AA, our subgroup analyses show that this marker could be useful for diagnosing AA in males. It also appears to be a potentially useful tool for discriminating complicated and uncomplicated AA. However, the limited number of included studies precludes drawing generalizable conclusions. Future prospective studies focused on males and in its potential ability to discriminate between complicated and uncomplicated AA are required.Registration. PROSPERO (CRD42023450988).

Usefulness of extended inflammatory parameters related to neutrophil activation reported by Sysmex XN-1000 hematology analyzer for predicting complicated acute appendicitis. Comparison with canonical inflammatory laboratory tests.

AIM: Accurate diagnosis of complicated appendicitis is of importance to ensure that patients receive early and effective treatment, minimizing the risk of postoperative complications to promote successful recovery. Biochemical markers are a promising tool to identify complicated appendicitis. We aimed to evaluate the potential role of novel parameters related with neutrophil activation, known as "Extended Inflammation Parameters" (EIP), included in blood cell count reported by Sysmex XN-Series analyzers, compared to other canonical biomarkers in identifying complicated appendicitis. METHOD: Prospective observational study including patients with confirmed diagnosis of acute appendicitis. C-reactive protein (CRP), procalcitonin, cell blood count, including white blood cell (WBC), absolute neutrophil (ANC) and immature granulocyte (IG) count and EIP (neutrophil reactivity [NEUT-RI] and granularity intensity [NEUT-GI]) were analyzed before surgery. Their accuracy to diagnose complicated appendicitis was tested in an ROC curve analysis. RESULTS: Our population study included 119 patients, and appendicitis was complicated in 58 (48.7%). NLR, CRP and procalcitonin levels, ANC and IG count and NEUT-RI and NEUT-GI were higher in patients with complicated appendicitis. Regarding accuracy for complicated appendicitis, CRP was the biomarker with the highest performance (ROC AUC: 0.829), with an optimal cutoff of 73.1 mg/L (sensitivity: 63.8%, specificity: 88.5%). NEUT-RI and NEUT-GI achieved both significant but poor accuracy, with ROC AUC of 0.606 and 0.637, respectively. CONCLUSIONS: Novel laboratory tests reported by Sysmex XN-Series analyzers have poor accuracy for identifying complicated appendicitis. In this study, CRP was the biomarker with the highest performance and may be useful as predictor of the severity of acute appendicitis.

Blood biomarkers to distinguish complicated and uncomplicated appendicitis in pediatric patients.

BACKGROUND/PURPOSE: Acute appendicitis (AA) stands as the most prevalent cause of acute abdominal pain among children. The potential for morbidity escalates significantly when uncomplicated appendicitis (UA) progresses to complicated appendicitis (CA), which can encompass gangrenous, necrotic, or perforated appendicitis. Consequently, establishing an early and accurate diagnosis of AA, and effectively differentiating CA from UA, becomes paramount. This study explores the diagnostic utility of various blood biomarkers for distinguishing CA from UA in pediatric patients. METHODS: We conducted a retrospective review of medical records pertaining to pediatric patients who underwent surgery for AA. Patients were categorized as either having UA or CA based on histopathological examination of the appendix. The data collected and analyzed included demographic information, white blood cell (WBC) count, neutrophil proportion, lymphocyte proportion, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) levels upon admission. RESULTS: Among the 192 pediatric patients who underwent surgery for AA, 150 were diagnosed with UA, while 42 were diagnosed with CA. The CA group exhibited significantly higher neutrophil proportions, NLRs, PLRs, and CRP levels, alongside lower lymphocyte proportions (all p < 0.01) compared to the UA group. Receiver operating characteristic (ROC) curve analysis disclosed that CRP exhibited the highest specificity, sensitivity, and positive and negative predictive values for predicting CA. CONCLUSION: CRP emerges as a valuable biomarker for differentiating complicated appendicitis from uncomplicated appendicitis.

Predicting Complicated Appendicitis Based on Neutrophil to Lymphocyte Ratio, A Study in University Hospital of Nepal.

Background Acute appendicitis is one of the most common causes of acute abdomen requiring surgical treatment. Accurately diagnosing appendicitis and identifying complicated appendicitis can be difficult at times. Objective To evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to differentiate between uncomplicated and complicated appendicitis. Method This was a prospective hospital-based observational study conducted at the Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital from July 2021 to December 2022. Patients with the clinical diagnosis of acute appendicitis who had undergone emergency appendectomy were included in the study. Informed consent was taken from each patient and data collection was done by filling the proforma. Result A total of 218 patients were included in the study. Male: female ratio was 1.18:1. Mean age of patients was 28.58 ± 16.65 (3-78) years. A significant correlation was found between increasing neutrophil count and neutrophil-to-lymphocyte ratio with complicated appendicitis. However, no significant correlation was found between White Blood Cell counts and complicated appendicitis. Neutrophil-to-lymphocyte ratio > 12.6 was found to be associated with complicated appendicitis. Conclusion A simple, cost-effective, and yet perfect test is not available for identifying complicated appendicitis. Increased Neutrophil count and neutrophil-to-lymphocyte ratio can indicate complicated appendicitis. Elevated WBC counts alone has no role in differentiating complicated appendicitis. According to the results of our study, an neutrophil-to-lymphocyte ratio of 12.6 can help to differentiate complicated from uncomplicated appendicitis.