Abstract
BackgroundThis retrospective study aimed to evaluate the ability of the delta neutrophil index (DNI) to predict histologically normal appendicitis preoperatively and to differentiate between simple and complicated appendicitis.MethodsThe data from 650 patients were divided into positive and negative appendectomy groups (histologically normal appendicitis). The patients in the acute appendicitis group were further sub-divided into simple and complicated appendicitis groups.ResultsThe DNI was significantly higher in the positive group than in the negative appendectomy group (0.4 vs. −0.4, p < 0.001) as well as in the complicated group compared with that in the simple appendicitis group (1.2 vs. 0.3, p < 0.001). The DNI independently predicted a positive appendectomy and an acute complicated appendicitis in multivariate logistic regression analysis [odds ratio (OR) 2.62, 95% confidence interval (CI) (1.11~6.16), p = 0.028 and odds ratio (OR) 4.10, 95% confidence interval (CI) (2.94~5.80), p < 0.001]. The optimum cut-off for a positive appendectomy and acute complicated appendicitis were 0.2 [area under curve (AUC) 0.709] and 0.6 (AUC 0.727).ConclusionsWe suggest that obtaining a preoperative DNI is a useful parameter to aid in the diagnosis of histologically normal appendicitis and to differentiate between simple and complicated appendicitis.
Highlights
This retrospective study aimed to evaluate the ability of the delta neutrophil index (DNI) to predict histologically normal appendicitis preoperatively and to differentiate between simple and complicated appendicitis
We investigated the usefulness of the DNI as an early predictor of acute appendicitis and acute complicated appendicitis in adults
The proportion of females was higher in the negative appendectomy group than in the positive appendectomy group (62.9 vs. 48.0%, p = 0.086), this difference was not statistically significant (Table 1)
Summary
This retrospective study aimed to evaluate the ability of the delta neutrophil index (DNI) to predict histologically normal appendicitis preoperatively and to differentiate between simple and complicated appendicitis. Acute appendicitis is the most common cause of acute abdominal pain requiring urgent surgical intervention in an emergency department (ED) [1, 2]. Several blood tests are used to aid diagnosis of acute appendicitis. An elevated white blood cell (WBC) count has a low predictive value because the WBC is elevated in up to 70% of Immature granulocytes are an indicator of increased myeloid cell production and are known to increase in infectious or inflammation conditions [9,10,11,12,13,14]. The delta neutrophil index (DNI) measures the fraction of immature granulocytes in the circulation and has recently been introduced as a new inflammatory marker [15,16,17]. The DNI is assessed by an automated blood cell analyzer, and tests required for the DNI can be performed simultaneously with the routine complete blood
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