Complicated Appendicitis Group Research Articles

Diagnostic value of basic laboratory parameters in the diagnosis of complicated appendicitis

In this investigation, we sought to examine the efficacy of laboratory parameters in predicting complicated appendicitis in patients who had surgery for acute appendicitis. 153 patients who underwent appendectomy were included and whose pathological results showed acute appendicitis. The patients were divided into two groups based on pathology findings and surgical findings: simple and complicated appendicitis groups. The patients’ age, gender, preoperative leukocyte count, neutrophil count, neutrophil percentage, neutrophil–lymphocyte ratio, erythrocyte distribution width, mean platelet volume, and C-reactive protein levels were recorded. The simple and complicated appendicitis groups comprised 97 and 56 patients, respectively. Patients with complicated appendicitis were older on average than those with simple appendicitis (p=0.007). In the complicated appendicitis group, leukocyte count (p

The Role of Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) in Appendicitis

Aim: Predictive values of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with poor outcomes in several diseases. Furthermore, there has been limited publication of those parameters in appendicitis patients in Indonesia. This study aims to evaluate the role of NLR and PLR in differentiating complicated appendicitis and uncomplicated appendicitis. Methods: The design of this study is a retrospective using medical records of appendicitis patients from January 1, 2016, to December 31, 2020, conducted at PKU Muhammadiyah Bantul Hospital. There are 408 data on appendicitis patients that can be analyzed. Results: The WBC, neutrophils, NLR, and PLR was significantly higher in the complicated appendicitis group than in the uncomplicated group [11,5 (3.79-35.2) vs. 8.42 (3.32-39.30), p<0.0001; 8.63 (2.359-2.647) vs. 5.446 (1.691-35.960), p<0.0001; 5.65 (0.95-23.86) vs.3.82 (0.81-23.86), p<0.0001; 168.57 (37.27-974.03) vs.139.40 (56.84-1274.31), p<0.0001, respectively] followed by a significantly lower lymphocyte count [1.709 (0.154-5.71) vs. 2.094 (0.401-5.812), p<0.0001, respectively]. The area under the receiver operating characteristic (ROC) curve, cutoff point, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio of NLR for diagnosis of complicated appendicitis were 0.76, >2.84, 75.21%, 62.65%, 74.6%, 63.4%, 2.01, 0.40, respectively. In contrast, an area under ROC curve, cutoff point, sensitivity, specificity, PPV, NPV, and likelihood ratio of PLR for differentiating complicated and uncomplicated appendicitis were 0.605, >140.6, 65.70%, 51.81%, 66.5%, 50.9%, 1.36, and 0.66 respectively. Conclusion: The cutoff values of NLR (>2.84) and PLR (>140.6) were significant diagnostic parameters for complicated appendicitis (p = 0.0001). Hence, NLR and PLR can assist in diagnosing complicated appendicitis.

Blood cell indices as predictors of complicated appendicitis: A diagnostic study

BackgroundAppendicitis in children is associated with diagnostic complexity leading to delayed diagnosis. Such delays risk progression to complicated appendicitis. This study investigates the potential of cellular indices, including neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), to differentiate uncomplicated (UA) from complicated appendicitis (CA). MethodsDiagnostic study of pediatric patients with acute appendicitis admitted to our hospital from 2021 to 2022. NLR, dNLR, PLR and MLR were compared between groups. ResultsA total of 182 patients were enrolled: 116 cases with CA (63 % male, age 9.6 ± 5.5 years) and 66 patients with UA (67 % male, age 10.6 ± 2.7 years). All blood cell indices were significantly higher in the CA group than in the UA group (p= <0.0001). NLR, dNLR and PLR have a good area under the receiver operating characteristic (ROC) curve, whereas MLR has a regular curve (0.735). PLR was the most accurate predictor of CA with a sensitivity of 60 %, specificity of 85 %, positive predictive value of 88 %, area under the ROC curve of 0.802 (95 % CI 0.737–0.866) and a cut-off point for the diagnosis of CA of 213.3. The post-test probability of CA for a positive result on PLR was 80 % (95 % CI 69–88). ConclusionsPLR seems to be the most accurate cellular index to differentiate uncomplicated from complicated appendicitis in children. It may be useful for prioritizing cases for surgery as a predictor of intraoperative findings and early postoperative courses.

Utility of Ischemia-Modified Albumin as a Biomarker for Acute Appendicitis: A Systematic Review and Meta-Analysis.

Acute appendicitis is a frequently encountered surgical emergency. Despite several scoring systems, the possibility of delayed diagnosis persists. In addition, a delayed diagnosis leads to an increased risk of complicated appendicitis. Hence, there is a need to identify biological markers to help clinicians rapidly and accurately diagnose and prognosticate acute appendicitis with a high sensitivity and specificity. Although several markers have been evaluated, the pressing concern is still the low specificity of these markers. One such marker is serum ischemia-modified albumin (IMA), which can be a novel biomarker for accurately diagnosing and prognosticating acute appendicitis. The authors conducted a systematic search of the PubMed, EMBASE, Web of Science, and Scopus databases through February 2023 as per the PRISMA guidelines. The difference in the levels of IMA between patients with acute appendicitis vs. healthy controls, and the difference in the levels of IMA between patients with complicated vs. non-complicated acute appendicitis were taken as the outcome measures. Statistical analysis was performed using a random effects model and mean difference (MD) was calculated. The methodological quality of the studies was assessed by utilizing the Newcastle-Ottawa scale. A total of six prospective comparative studies were included in the meta-analysis. The analysis revealed that the mean level of serum IMA was significantly raised in the acute appendicitis group (MD 0.21, 95% CI 0.05 to 0.37, p = 0.01). Similarly, the mean serum IMA levels were also raised in the complicated appendicitis group compared to the non-complicated appendicitis group (MD 0.05, 95% CI 0.01 to 0.10, p = 0.02). Three of the studies included were, however, of poor methodological quality. Serum IMA is a viable potential marker for diagnosing and prognosticating acute appendicitis. However, due to the limited methodological quality of available studies, further prospectively designed and adequately powered studies are needed.

The predictive value of the C-reactive protein/albumin ratio in adult patients with complicated appendicitis

Abstract Objectives The purpose of this study was to analyze the role of C-reactive protein/albumin ratio (CRP/ALB) in the diagnosis of complicated appendicitis in adults. Methods A retrospective analysis of 202 patients with acute appendicitis admitted to the Emergency Department of Weifang People’s Hospital between January 2021 and December 2022 was conducted. Patients were classified into complicated appendicitis group (CA) and non-complicated appendicitis group (NCA) based on postoperative pathological diagnosis, and the two groups were compared in terms of preoperative age, gender, white blood cell count (WBCC), C-reactive protein/albumin ratio (CRP/ALB), serum sodium (Na), and fibrinogen (FIB). Results The 202 cases of acute appendicitis in this study, 36.6 % (n=74) were CA. Multivariate logistic regression analysis showed that CPR/ALB (p≤0.001), FIB (p&lt;0.001), and Na (p=0.011) were risk factors for complicated appendicitis. The results of receiver operating characteristic (ROC) analysis, conducted to evaluate the role of CRP/ALB, Na, and FIB in detecting CA, showed that the area under the curve (AUC) of CRP/ALB was 0.871, which was higher than that of FIB and Na. CRP/ALB ratio ≥1.04 was an important indicator for predicting complicated appendicitis, with a sensitivity of 78.2 % and specificity of 84.7 %. Conclusions CRP/ALB ratio can serve as a good indicator for predicting complicated appendicitis.

Therapeutic strategy for acute appendicitis based on laparoscopic surgery

PurposeThe treatment strategies for acute appendicitis differ depending on the facility, and various studies have investigated the usefulness of conservative treatment with antibiotics, laparoscopic surgery, and interval appendectomy (IA). However, although laparoscopic surgery is widely used, the clinical strategy for acute appendicitis, especially complicated cases, remains controversial. We assessed a laparoscopic surgery-based treatment strategy for all patients diagnosed with appendicitis, including those with complicated appendicitis (CA).MethodsWe retrospectively analysed patients with acute appendicitis treated in our institution between January 2013 and December 2021. Patients were classified into uncomplicated appendicitis (UA) and CA groups based on computed tomography (CT) findings on the first visit, and the treatment course was subsequently compared.ResultsOf 305 participants, 218 were diagnosed with UA and 87 with CA, with surgery performed in 159 cases. Laparoscopic surgery was attempted in 153 cases and had a completion rate of 94.8% (145/153). All open laparotomy transition cases (n = 8) were emergency CA surgery cases. No significant differences were found in the incidence of postoperative complications in successful emergency laparoscopic surgeries. In univariate and multivariate analyses for the conversion to open laparotomy in CA, only the number of days from onset to surgery ≥ 6 days was an independent risk factor (odds ratio: 11.80; P < 0.01).ConclusionLaparoscopic surgery is preferred in all appendicitis cases, including CA. Since laparoscopic surgery is difficult for CA when several days from the onset have passed, it is necessary that surgeons make an early decision on whether to operate.

Analysis of risk factors for complicated appendicitis during pregnancy and evaluation of clinical prediction model: A prospective cohort study

ObjectiveTo investigate the risk factors and the value of clinical prediction model for complicated appendicitis (CA) during pregnancy. MethodsProspective analysis of pregnant patients who underwent appendectomy at a single tertiary care center between February 2020 and February 2023 and who ultimately had pathologically confirmed acute appendicitis (AA). According to intraoperative conditions and postoperative pathology, they were divided into the CA group and the uncomplicated appendicitis (UA) group. The two groups of patients were then compared in terms of demographic characteristics, disease features, ancillary tests and predictive models of acute appendicitis. ResultsA total of 90 patients with AA in pregnancy were included, 21 of whom had CA in pregnancy and 69 had UA in pregnancy. Multivariate regression analysis showed that gestational week, neutrophil ratio and C-reactive protein (CRP) were independent risk factors for CA during pregnancy. Relative to the first trimester, the third trimesters had an increased risk of complicated appendicitis (OR = 12.48, 95% CI: 1.56–99.57, P = 0.017). Neutrophil ratio ≥85.30% (OR = 24.54, 95% CI: 2.59–232.72, P = 0.005) and CRP ≥34.26 mg/L (OR = 7.86, 95% CI: 2.18–28.38, P = 0.002) had a significantly increased risk of CA. The AIR and AAS score models were statistically different between the two groups, but with a lower sensitivity of 52.38% and 42.86%, respectively. ConclusionThe third trimesters, neutrophil ratio ≥85.30% and CRP ≥34.26 mg/L may be key predictors of CA in pregnancy. The current scoring model is inadequate to identify complex appendicitis in pregnancy and further research is needed.

Correlation Analysis of Lactic Acid Level as A Predictor of Severity of Patients with Acute Appendicitis

Perforated appendicitis is a leading cause of morbidity and mortality in all appendicitis cases, both for adults and children. Delay in preoperative diagnosis is the main reason for perforation. In previous studies, it was revealed that diagnostic modalities such as radiological examination and the current scoring system have not been able to predict the onset of perforated appendicitis. Serological biomarkers of lactic acid are associated with intestinal obstruction and ischemia. The increase in the serological value of lactic acid in perforated appendicitis compared to acute one was shown to increase significantly by 0.25 mmol/L (p&lt;0.05) according to a previous study. This study aimed to determine the correlation between lactic acid level and the severity of appendicitis in patients visiting Dr. Hasan Sadikin General Hospital. This was a cross-sectional prospective analytic observational study on adult patients diagnosed with appendicitis who were admitted to the emergency room of Dr. Hasan Sadikin General Hospital from January 1, 2021 to June 1, 2021. Data analysis was performed using bivariate analysis and correlation tests of difference. This study involved 54 subjects with a mean lactic acid level of 2,5093 mmol/L (0.9 mmol/L - 11.8 mmol/L). In the complicated appendicitis group, 20 subjects (37%) was found to experience an increase in lactic acid (OR 1.07; 95% CI: -0.03-0.22; p=0.14). The correlation analysis showed the direction of negative correlation. Thus, it is concluded that there is no significant correlation between lactic acid level and the severity of appendicitis in patients with appendicitis.

Complicated and uncomplicated acute appendicitis in pregnancy: a single center experience

Objectives: Acute appendicitis is the most common non-obstetric pathology requiring emergency surgery on pregnant women. The aim of the study is to show the effect of uncomplicated and complicated acute appendicitis on pregnancy. Methods: This study was conducted retrospectively at the Department of General Surgery of Konya City Hospital. Pregnant patients who underwent surgery for acute appendicitis from January 1, 2020, through December 31, 2021, were included in the study. The cases were divided into two groups as complicated and uncomplicated appendicitis and compared. The demographic, clinical, and laboratory findings of the patients were obtained by screening the patient files. The cases were divided into two groups as complicated and uncomplicated appendicitis and compared. Results: The study included 46 pregnant patients with a mean age of 25.9 years. The mean gestational age of the patients at the time of surgery was 16.5 weeks. Of the patients, 47.8% were in the first trimester. Open appendectomy was performed in 35 (76.1%) patients, and laparoscopic appendectomy in eight (17.4%). Seven (15.2%) appendicitis cases were complicated. A negative appendectomy was performed in two (4.3%) patients. Preterm labor was seen at a rate of 28.6% in the complicated appendicitis group and 5.1% in the uncomplicated appendicitis group (p = 0.04), and the mean operative times were 65.8 and 46.1 minutes, respectively (p &amp;lt; 0.001). Conclusions: Both postoperative complications due to surgery and obstetric complications increase in patients with complicated appendicitis; therefore, it is particularly important to closely follow up these cases.

Establishment of predictive models for acute complicated appendicitis during pregnancy-A retrospective case-control study.

To develop a scoring system based on clinical and imaging features to distinguish complicated appendicitis (CA) from uncomplicated appendicitis (UCA) during pregnancy. This was a retrospective case-control study. Patients diagnosed with acute appendicitis during pregnancy were included, and they were divided into a CA group and a UCA group based on the intraoperative findings and the biopsy results. Multivariate logistic regression and machine learning were employed to establish a predictive model. A total of 342 patients were included in this study. Among them, 141 (41.23%) patients were diagnosed with CA. The predictive model contained six indices, including symptom duration time more than 24 h, fever, heart rate at least 98 beats/minute, monocyte count at least 0.72 × 109 /L, lymphocyte count at least 1× 109 /L and direct bilirubin at least 4.75 μmol/L. The total score was 31 points, and a score of more than 15.5 points predicted the development of CA during pregnancy with area under the curve (AUC) of 0.80 (95% confidence interval 0.75-0.84) and specificity of 0.84. A decision flow chart for distinguishing CA from UCA during pregnancy was developed by Decision Tree with an AUC of 0.78. The models combining clinical findings and laboratory tests, developed by two methods, can distinguish CA from UCA in pregnancy in a convenient and visualized way. The research has been registered in Chinese Clinical Trial Registry on January 7, 2022 with registration ID ChiCTR2200055339.

Evaluation of systemic immune-inflammation index efficacy in predicting complicated appendicitis in pediatric emergency department.

Acute appendicitis (AA) is one of the most important causes of acute abdominal pain in children who are admitted to the pediatric emergency department. This study aims to determine the usefulness of the systemic immune-inflammation index (SII) in predicting complicated appendicitis (CA) in pediatric patients. The patients who underwent surgery with the diagnosis of AA were evaluated retrospectively. AA and control groups were formed. AA was divided into noncomplicated and CA groups. C-reactive protein (CRP), white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count, neutrophil/lymphocyte ratio (NLR), platelet (PLT)/lymphocyte ratio (PLR), and SII values were recorded. The SII was calculated with the formula of PLT count × neutrophil/lymphocyte. The efficacy of biomarkers in predicting CA was compared. Our study included 1072 AA and 541 control patients. There were 74.3% of patients in the non-CA (NCA) group and 25.7% in the CA group. CRP, WBC count, ANC, NLR, PLR when AA and control group, complicated and NCA groups are compared in terms of laboratory parameters and SII level AA and it was higher in the CA group. While the SII value was 2164.91±1831.24 in the patients with NCA and 3132.59±2658.73 in those with CA (P<0.001). When the cut-off values were determined according to the area under the curve, CRP and SII were found to be the best biomarkers in predicting CA. Inflammation markers together with clinical evaluation may be useful in distinguishing noncomplicated and complicated AA. However, these parameters alone are not sufficient to predict CA. CRP and SII are the best predictors of CA in pediatric patients.

Systemic inflammation response index and systemic immune-inflammation index for predicting complications of acute appendicitis: A retrospective study

Objective: To investigate the value of systemic inflammatory response index (SIRI) and systemic immune-inflammation index (SII) in predicating acute appendicitis complications based on hemogram parameters.Methods: Demographic data, histopathological studies, and laboratory results of the patients who were admitted to the emergency department with a complaint of abdominal pain between January 2020 and June 2022 and were hospitalized with the diagnosis of acute appendicitis for operation by general surgery were examined. Simple appendicitis and complicated appendicitis groups were compared in terms of parameters according to their histopathological examinations.Results: A total of 220 patients who met the inclusion criteria were included in our study. Mean SIRI levels were found to be significantly higher in the complicated appendicitis group than in the simple appendicitis group [6.60 (4.07, 14.40) vs. 3.50 (2.20, 6.80); P=0.002]. Similarly, SII levels were found to be significantly higher in the complicated appendicitis group compared to the simple appendicitis group [2 514.50 (1 132.25, 5 388.00) vs. 1 207.00 (571.50, 2 089.00), P<0.001]. The power of SIRI and SII to indicate complications was higher than white blood cell count and C-reactive protein (area under the curve: 0.753 and 0.786, respectively).Conclusion: SIRI and SII could be used to indicate complications in patients with acute appendicitis.

The Value of Complete Blood Count Parameters in Predicting Complicated Acute Appendicitis; a Prognostic Accuracy Study.

Low accuracy of clinical variables can result in delayed diagnosis and increase the incidence of complicated appendicitis in some cases. This study aimed to determine the value of simple complete blood count (CBC) biomarkers in predicting complicated appendicitis. This is a single-center retrospective cross-sectional study, which was conducted on cases referred to emergency department following acute appendicitis who underwent appendectomy, to evaluate the accuracy of some cell blood count variables (white blood cell count (WBC), neutrophil percent, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV)) in predicting complicated cases (gangrenous and ruptured appendicitis). There were 252 (68.3%) patients in the uncomplicated appendicitis group and 117 (31.7%) patients in the complicated appendicitis group. The mean age of patients was 34.1 ± 1.09 (Range: 18 -79) years (55.3% male). There were no differences between groups regarding the mean age (p = 0.053), gender distribution (p=0.07), Alvarado score (p = 0.055), platelet count (p =0.204), PLR (p = 0.115), and MPV (p = 0.205). The complicated appendicitis cases had longer onset of symptoms (p <0.001), higher WBC count (p = 0.011), higher neutrophil count (p < 0.001), and higher NLR (p < 0.001). Neutrophil count (area under the curve (AUC) = 0.61, 95% confidence interval (CI) = 0.56-0.66; p = 0.001) and NLR (AUC = 0.65, 95% CI = 0.60-0.69; p = 0.001) had higher level of accuracy in this regard. In contrast, the area under the curve of WBC count (AUC = 0.57, 95% CI = 0.52-0.63; p = 0.22), platelet count (AUC = 0.44, 95% CI = 0.38-0.49; p = 0.049), PLR (AUC = 0.57, 95% CI = 0.52-0.62; p = 0.026), and MPV (AUC = 0.54, 95% CI = 0.49-0.60; p = 0.193) showed low accuracy in predicting complicated acute appendicitis. Based on the findings of present study it seems that WBC, neutrophil percent, NLR, PLR, and MPV have failed to poor accuracy in predicting cases with complicated appendicitis in emergency department.

Discordance between Subjective and Objective Assessments of Activity after Pediatric Appendectomy

BackgroundPhysical activity recovery after pediatric surgery can be assessed using objective measures such as step counts, but practice currently relies on subjective assessment by proxy. It is unclear how subjective and objective assessments of activity relate. We compared caregiver assessment of return to normal physical activity after pediatric appendectomy to step count recovery measured by a Fitbit. MethodsPediatric patients who underwent appendectomy were recruited between 2020 and 2022 to be monitored for 21 d with a Fitbit. Patients were grouped by the postoperative day (POD) (7, 14, or 21) their caregiver first reported their activity was “back to normal.” Objective return to normal step count was estimated for each group by modeling the inflection point from increasing steps to a plateau. These measures were determined discordant if the subjective report remained outside the modeled 95% confidence interval (CI) for the day the group plateaued. ResultsThirty-nine simple appendicitis and 40 complicated appendicitis patients were recruited. Among simple appendicitis patients, daily steps plateaued on POD 10.8 (95% CI 7.4-14.3), POD 14.0 (95% CI 11.0-17.1), and POD 11.1 (95% CI 6.9-15.3) for the day 7, day 14, and day 21 groups, respectively. Complicated appendicitis groups plateaued on POD 12.8 (95% CI 8.7-16.9), POD 15.2 (95% CI 11.1-19.3), and POD 16.7 (95% CI 12.3-21.0), respectively. Significant discordance was observed between subjective and objective assessments for the day 7 and day 14 simple groups and for the day 7 complicated group. ConclusionsThere was significant discordance between caregiver and accelerometer-assessed activity recovery after pediatric surgery. Development of objective measures of recovery could help standardize assessment of children's recovery after surgery.

Development and Validation of a Clinical Prediction Model for Complicated Appendicitis in the Elderly.

BackgroundFor elderly patients with mild clinical symptoms of uncomplicated appendicitis(UA), non-surgical treatment has been shown to be feasible, whereas emergency surgical treatment is recommended in elderly patients with complicated appendicitis(CA), but it is still challenging to accurately distinguish CA and UA before treatment. This study aimed to develop a predictive model to assist clinicians to quickly determine the type of acute appendicitis.MethodsWe retrospectively studied the clinical data of elderly patients with acute appendicitis who visited the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2012 to January 2022. The patients were divided into UA group and CA group, and the general conditions, medical history, physical examination, laboratory examination and imaging examination were compared between the two groups, and SPSS 26.0 and R 4.0.2 software were used to establish CA clinic. Predict the model, and validate it internally.ResultsThe clinical data of 441 elderly patients with acute appendicitis were collected, 119 patients were excluded due to incomplete clinical data or other diseases. Finally, 332 patients were included in the study and divided into UA group (n = 229) and CA group (n = 103). By analyzing the clinical data of the two groups of patients, the duration of abdominal pain [OR = 1.094, 95% CI (1.056–1.134)], peritonitis [OR = 8.486, 95% CI (2.017–35.703))] and total bilirubin [OR = 1.987, 95% CI (1.627–2.426)] were independent predictors of CA (all p < 0.01). The model's Area Under Curve(AUC) = 0.985 (95% CI, 0.975–0.994). After internal verification by Bootstrap method, the model still has high discriminative ability (AUC = 0.983), and its predicted CA curve is still in good agreement with the actual clinical CA curve.ConclusionWe found that a clinical prediction model based on abdominal pain duration, peritonitis, and total bilirubin can help clinicians quickly and effectively identify UA or CA before treatment of acute appendicitis in the elderly, so as to make more scientific clinical decisions.

The use of the ratio of C-reactive protein to albumin for the diagnosis of complicated appendicitis in children

No reliably specific marker for complicated appendicitis has been identified. The ratio of serum C-reactive protein (CRP) to albumin (ALB) (CRP/ALB ratio) is a new inflammation-based prognostic score that is associated with the severity of inflammation. The aim of this study was to evaluate the predictive value of CRP/ALB ratio for the diagnosis of complicated appendicitis in children. A retrospective study of 296 children with acute appendicitis was conducted with assessments of demographic data, clinical symptoms, pre-operative laboratory results, abdominal ultrasound examinations and clinical outcomes. According to the postoperative pathological results, patients were divided into a simple appendicitis group (169 patients) and a complicated appendicitis group (127 patients). SPSS version 22.0 was used to analyse the data. Of the 296 patients, CRP/ALB ratio was higher in complicated appendicitis than in simple appendicitis (P<0.05). Logistic regression analysis showed that higher levels of white blood cell count (WBC), CRP, CRP/ALB ratio, and increased incidence in submucosal layer loss and appendicolith were independent risk factors for complicated appendicitis in children. Receiver operating characteristic curve analysis showed that the area under the curve of the CRP/ALB ratio (0.883) was larger than that of WBC (0.702), CRP (0.802), ALB (0.835), submucosal layer loss (0.633) and appendicolith (0.673). A CRP/ALB ratio≥1.39 was found to be a significant marker in the prediction of complicated appendicitis, with 86.61% sensitivity and 84.62% specificity. Patients with a CRP/ALB ratio≥1.39 had a 31.263 times higher chance of having complicated appendicitis (95% CI: 16.449-59.418) than those with a CRP/ALB ratio<1.39. The admission CRP/ALB ratio was significantly higher in children with complicated appendicitis. The CRP/ALB ratio is a novel but promising haematological marker that aids in the differentiation of acute complicated and simple appendicitis.

Role of Hyperbilirubinaemia as a Predictor of Complicated Appendicitis in Paediatric Population.

Background:Acute appendicitis is a common surgical emergency amongst the paediatric population. Available diagnostic tools are focussed to make a diagnosis of acute appendicitis. A definitive predictive factor for the diagnosis of complicated appendicitis is lacking. Thus, this aims to analyse hyperbilirubinaemia as a predictor of complicated appendicitis amongst the paediatric population.Materials and Methods:A prospective observational study was conducted in a tertiary hospital from November 2018 to October 2019. All children undergoing emergency appendectomy were included in the study. Preoperatively, patients were evaluated clinically, and routine investigations including total and direct serum bilirubin were sent. All patients were grouped as ‘simple appendicitis’ or ’complicated appendicitis’ based on intra-operative and histological findings. Bilirubin level was compared between these groups and analysed.Results:A total of 52 children fulfilling the inclusion criteria were included. The mean age was 13.2 ± 4.2 years, and the male: female ratio was 2.1:1. Thirty-four (65.4%) had simple appendicitis and 18 (34.6%) had complicated appendicitis. Total bilirubin was 23.83 ± 5.94 mmol/L in the complicated appendicitis group and 13.15 ± 3.29 mmol/L in the simple appendicitis group. Direct bilirubin was 5.28 ± 2.22 mmol/L in complicated appendicitis and 2.62 ± 0.83 mmol/L in simple one. Both total and direct bilirubin were significantly high in the complicated group (P < 0.001) compared to the simple appendicitis group. On the Receiver operating curve (ROC), the best cutoff value for total and direct bilirubin was 21 and 5.5 mmol/L, respectively. The sensitivity and specificity of total and direct bilirubin were 72.2%, 100%, and 61.1%, and 85.3%, respectively.Conclusion:It is concluded that hyperbilirubinaemia is a good predictor for paediatric complicated appendicitis.

Complicated or non-complicated appendicitis? That is the question.

Acute appendicitis (AA) is a common disease that includes all age groups and both genders in societies and is one of the most common causes of acute abdomen. It is important to distinguish between complicated and non-complicated appendicitis before surgery. This study aims to determine laboratory parameters that can be used to determine whether the disease is complicated or non-complicated in patients admitted to the emergency department with AA. Female and male patients admitted to the Emergency General Surgery Department between May 2019 and November 2020 and diagnosed with appendicitis were included in the study. Demographic data (age, gender, and protocol numbers), complete blood counts (Delta neutrophil index [DNI], hemoglobin, monocyte, neutrophil, eosinophil, basophil, platelet, platelet distribution width, mean platelet volume, reticulocyte distribution width), biochemical parameters (amylase, direct bilirubin, indirect bilirubin, albumin, calcium, and lactate dehydrogenase), and examination information were obtained from the hospital automation system and recorded via SPSS software. Parameters of patients were divided into two groups as complicated and non-complicated appendicitis groups were compared. White blood cell (WBC), monocyte, neutrophil, DNI, total bilirubin, and direct bilirubin values were found to be statisti-cally significantly higher in the complicated appendicitis group compared to the non-complicated appendicitis group (p-values; <0.001, 0.003, <0.001, <0.001 and 0.008, respectively). DNI, bilirubin values, WBC, monocyte, neutrophil, and eosinophil can be used as laboratory parameters to distin-guish between complicated and non-complicated AA.

MONOCYTE DISTRIBUTION WIDTH; CAN IT BE USED AS AN EARLY DIAGNOSIS MARKER IN CASES OF ACUTE COMPLICATED APPENDICITIS? A PRELIMINARY STUDY

AİM : The aim of this study was to investigate the effectiveness of monocyte distribution width in both the diagnosis of acute appendicitis (AA) and in differentiating between simple appendicitis (SA) and complicated appendicitis (CA).&#x0D; &#x0D; METHODS: This study was conducted using data from 107 adult patients who underwent appendectomy. Demographic details, preoperative white blood cell (WBC) count, immature granulocyte count (IG) and percentage (IG %), monocyte distribution width (MDW), neutrophil-lymphocyte ratio (NLR) and pathology results were evaluated retrospectively. Patients were grouped as AA and normal appendix (NA) according to the pathology reports, and the AA cases were divided into SA and CA groups according to the intraoperative findings.&#x0D; &#x0D; RESULTS: WBC, IG, IG%, NLR and MDW values were found to be statistically significant for the differentiation of acute appendicitis from normal appendicitis cases (p &lt; 0.05). Of these parameters, the strongest parameter for the diagnosis of AA was NLR (sensitivity: 76%, specificity: 89%, p&lt; 0.001). The IG value was found to be statistically significant in the diagnosis of complicated appendicitis cases (p &lt; 0.05)&#x0D; &#x0D; CONCLUSION: The MDW value is a fast, reliable and easily accessible parameter in the diagnosis of AA. However, although MDW values were found to be high in CA cases in the differentiation of SA and CA, they were not statistically significant. More comprehensive studies are needed for a clearer assessment.

CT based Acute Appendicitis Severity Index for acute appendicitis and validate its effectiveness in predicting complicated appendicitis.

To propose a CT-based scoring system called Acute Appendicitis Severity Index (AASI) for diagnosis of acute appendicitis and validates its effectiveness in predicting complicated appendicitis. Retrospective analyses of CT images of 120 adult patients with pathologically proven uncomplicated (n = 64) and complicated (n = 56) acute appendicitis were performed. All patients had undergone a CT scan of the abdomen and pelvis using 320 multi-detectors computed tomography with Adaptive Iterative Dose Reduction 3D (AIDR 3D). CT image parameters were identified and used to develop a CT-based scoring system (AASI) to predict the severity of acute appendicitis and its outcome. All image analysis was performed by 2 radiologists and the total score was assigned to each patient based on the proposed CT scoring system. Validation of the effectiveness of the proposed scoring system (AASI) was done using statistical models. The mean and standard deviation of AASI was found to be significantly higher (P value = 0.001) in the complicated appendicitis group (observer 1 = 10.2 ± 1.6 and observer 2 = 9.63 ± 2.3) as compared to that in uncomplicated acute appendicitis group (observer 1 = 7.09 ± 2.2 and observer 2 = 6.38 ± 1.9). There was an excellent interobserver agreement of the Acute Appendicitis Severity Index for both the uncomplicated and complicated appendicitis groups (K = 0.89, 95% CI = 0.87-0.92, P = 0.001). The cutoff value for AASI used to predict complicated appendicitis was taken as 9.5 and 8.5. This resulted in an AUC of 0.877 and 0.848, accuracy of 83% and 81%, the sensitivity of 75% and 80%, the specificity of 90% and 81%, the positive predictive value of 87% and 78%, and a negative predictive value of 81% and 83% by both reviewers respectively. The proposed CT-based AASI is a reliable parameter for the prediction of complicated appendicitis.