The Diagnostic Value of Systemic Inflammatory Markers in Acute Appendicitis

Document Type : Original Article

Authors

1 Innovative Medical Research Center, MMS.C., Islamic Azad University, Mashhad, Iran

2 Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Community Medicine, MMS.C., Islamic Azad University, Mashhad, Iran

4 Department of Emergency Medicine, Razavi Hospital, Mashhad, Iran

5 Department of General Surgery, MMS.C., Islamic Azad University, Mashhad, Iran

Abstract

Background: Early diagnosis of Acute Appendicitis (AA)can be challenging because it relies on the patient's signs and symptoms, which often mimic other abdominal pathologies.

Objectives: The study aimed to assess the importance of systemic inflammatory response parameters in contrast with the Alvarado scoring system.
 
Methods: This cross-sectional study was conducted on 300 patients diagnosed with AA who underwent an appendectomy. Demographic data, medical history, physical examination findings, Alvarado score, complete blood count (CBC), and pathology results of the appendix were documented.
 
Results: In a study involving 300 patients, 53.7% were male. The mean age of the patients was 37.24 ± 14.79 years. The number of females with a negative appendectomy was 2.45 times higher than that of males. Most patients with appendicitis were male, while most with RLH (reactive lymphoid hyperplasia) and normal appendices were female. For diagnosing AA, the following thresholds were established: NLR (neutrophil-to-lymphocyte ratio) >2.93 with 90.08% sensitivity and 76.32% specificity, PLR (platelet-to-lymphocyte ratio) >117.8 with 70.61% sensitivity and 65.79% specificity. The sensitivity of the Alvarado scoring system was 79.8%, and its specificity was 81.6% at >6 cut-off value.
 
Conclusion: NLR, PLR, CRP (C-reactive protein), SII (systemic immune inflammation index), and Alvarado scoring showed great potential in diagnosing appendicitis with acceptable sensitivity and specificity.

Keywords


Acknowledgements: The authors would like to thank all participants in this study. We also appreciate the support of Mashhad University of Medical Sciences for conducting this research.

 

Availability of data and materials: All data generated or analysed during this study are included in this published article.

 

Conflicts of interests: All authors declared that they have no competing interests.

 

Consent for publication: Not Applicable

 

Ethics approval and consent to participate: The present study has a code of ethics with an ID number (IR.MUMS.REC.1401.105).The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

 

Financial disclosure: No financial support was received for this study.

 

Author contributions: Conceptualization: TZ and MRT - Methodology and Formal analysis: YR and MM- Investigation, Data curation: MRT, TZ, YA and, AD - Writing- Original draft: MRT- Writing - review & editing: TZ.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1. Amini M, Zandbaf T, Alizadeh S, Jand Y, Hosseini A, Eshrati B, et al. The significance of Alvarado score in the diagnosis of acute appendicitis based on age and sex. Arak Medical University Journal. 2011;14(1).
 
2. Akbulut S, Yagin FH, Cicek IB, Koc C, Colak C, Yilmaz S. Prediction of Perforated and Nonperforated Acute Appendicitis Using Machine Learning-Based Explainable Artificial Intelligence. Diagnostics. 2023;13(6):1173.
https://doi.org/10.3390/diagnostics13061173
PMid:36980481 PMCid:PMC10047288  
 
3. Rajalingam VR, Mustafa A, Ayeni A, Mahmood F, Shammout S, Singhal S, et al. The role of neutrophil-lymphocyte-ratio (NLR) and platelet-lymphocyte-ratio (PLR) as a biomarker for distinguishing between complicated and uncomplicated appendicitis. Cureus. 2022;14(1).
https://doi.org/10.7759/cureus.21446
PMid:35223231 PMCid:PMC8857869  
 
4. Dezfuli SAT, Yazdani R, Khorasani M, Hosseinikhah SA. Comparison between the specificity and sensitivity of the RIPASA and Alvarado Scoring systems in the diagnosis of acute appendicitis among patients with complaints of right iliac fossa. AIMS Public Health. 2020;7(1):1.
https://doi.org/10.3934/publichealth.2020001
PMid:32258184 PMCid:PMC7109537  
 
5. Amini M, Hosseini A, Zandbaf T, Eshrati B, Alizadeh S, Mosayebi G, et al. The diagnostic value of blood antioxidants in the diagnosis of acute appendicitis. Arak Medical University Journal. 2010;13(4).  
 
6. Kalan M, Talbot D, Cunliffe W, Rich A. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Annals of the Royal College of Surgeons of England. 1994;76(6):418.  
 
7. Liu W, Wei Qiang J, Xun Sun R. Comparison of multislice computed tomography and clinical scores for diagnosing acute appendicitis. Journal of International Medical Research. 2015;43(3):341-9.
https://doi.org/10.1177/0300060514564475
PMid:25762518  
 
8. Narci H, Turk E, Karagulle E, Togan T, Karabulut K. The role of red cell distribution width in the diagnosis of acute appendicitis: a retrospective case-controlled study. World Journal of Emergency Surgery. 2013;8:1-5.
https://doi.org/10.1186/1749-7922-8-46
PMid:24216220 PMCid:PMC3826504  
 
9. Akbaş A, Kasap ZA, Hacım NA, Tokoçin M, Altınel Y, Yiğitbaş H, et al. The value of inflammatory markers in diagnosing acute appendicitis in pregnant patients. Turkish Journal of Trauma & Emergency Surgery/Ulusal Travma ve Acil Cerrahi Dergisi. 2020;26(5).
https://doi.org/10.14744/tjtes.2020.03456  
 
10. Cho SK, Jung S, Lee KJ, Kim JW. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis. BMC gastroenterology. 2018;18:1-6.
https://doi.org/10.1186/s12876-018-0748-4
PMid:29370777 PMCid:PMC5785858  
 
11. Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis. The American Journal of Surgery. 2020;219(1):154-63.
https://doi.org/10.1016/j.amjsurg.2019.04.018
PMid:31056211  
 
12. Siki FÖ, Sarıkaya M, Gunduz M, Sekmenli T, Korez MK, Ciftci I. Evaluation of the systemic immune inflammation index and the systemic inflammatory response index as new markers for the diagnosis of acute appendicitis in children. Annals of Saudi Medicine. 2023;43(5):329-38.
https://doi.org/10.5144/0256-4947.2023.329
PMid:37805819 PMCid:PMC10560368  
 
13. Cakcak İE, Türkyılmaz Z, Demirel T. Relationship between SIRI, SII values, and Alvarado score with complications of acute appendicitis during the COVID-19 pandemic. Turkish Journal of Trauma & Emergency Surgery. 2022;28(6):751.
https://doi.org/10.14744/tjtes.2021.94580
PMCid:PMC10443012  
 
14. Karabulut KU, Erinanc H, Yonar A, Kisinma A, Ucar Y. Correlation of histological diagnosis and laboratory findings in distinguishing acute appendicitis and lymphoid hyperplasia. Annals of Surgical Treatment and Research. 2022;103(5):306-11.
https://doi.org/10.4174/astr.2022.103.5.306
PMid:36452309 PMCid:PMC9678668  
 
15. Khan SA, Ashraf R, Hassaan N, Naseer M, Azad MH, Javed H. The role of neutrophil-to-lymphocyte ratio in the diagnosis of acute appendicitis. Cureus. 2023;15(12).
https://doi.org/10.7759/cureus.51164  
 
16. Ahmad KA, Ideris N, Abd Aziz SHS. A cross-sectional study of neutrophil-to-lymphocyte ratio in diagnosing acute appendicitis in hospital Melaka. The Malaysian journal of medical sciences: MJMS. 2019;26(6):55.
https://doi.org/10.21315/mjms2019.26.6.6
PMid:31908587 PMCid:PMC6939729  
 
17. Bom WJ, Scheijmans JC, Salminen P, Boermeester MA. Diagnosis of uncomplicated and complicated appendicitis in adults. Scandinavian Journal of Surgery. 2021;110(2):170-9.
https://doi.org/10.1177/14574969211008330
PMid:33851877 PMCid:PMC8258714  
 
18. Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. International surgery. 2013;97(4):299-304.
https://doi.org/10.9738/CC161.1
PMid:23294069 PMCid:PMC3727267  
 
19. Kim TH, Cho BS, Jung JH, Lee MS, Jang JH, Kim CN. Predictive factors to distinguish between patients with noncomplicated appendicitis and those with complicated appendicitis. Annals of coloproctology. 2015;31(5):192.
https://doi.org/10.3393/ac.2015.31.5.192
PMid:26576398 PMCid:PMC4644707  
 
20. Yesilalioglu S, Az A, Sogut O, Ergenc H, Demirel I. Systemic inflammatory markers for distinguishing uncomplicated and complicated acute appendicitis in adult patients. Northern Clinics of Istanbul. 2023;10(4):507-13
https://doi.org/10.14744/nci.2022.79027
PMid:37719245 PMCid:PMC10500250