Marker For Acute Appendicitis Research Articles

A Prospective Comparative Study on the Clinical Diagnostic Performance of Blood Inflammatory Markers in Acute Appendicitis.

Despite the substantial advancements in imaging techniques for the diagnosis and differential diagnosis of acute appendicitis (AA) over recent decades, the specificity and sensitivity of widely utilized laboratory biomarkers in clinical practice remain inadequate.This study aimed to investigate the diagnostic utility of commonly employed blood inflammatory markers for AA. A total of 399 participants who either sought medical care or underwent health examinations were enrolled in this prospective study. The cohort comprised 200 patients diagnosed with AA (AA group), 100 patients presenting with abdominal pain but without AA (AP group), and 99healthy individuals undergoing routine health check-ups (HC group). For all subjects, the following biomarkers were measured: plasma neutrophil gelatinase-associated lipocalin (NGAL), white blood cell count (WBC), neutrophil count (NEU), percentage of neutrophils (NEU%), neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP). The diagnostic performance of the observed indicators, both individually and in combination, was assessed for the diagnosis of AA using Receiver Operating Characteristic (ROC) curves analysis and Delong's test. The laboratory indicators demonstrated a progressive increase from the HC group to the AP group, and further to the AA group (all p<0.05). Multifactorial logistic regression analysis identified NEU% and plasma NGAL as significant risk factors for the occurrence of AA. ROC curve analysis and Delong's test indicated that, in distinguishing the AA group from the HC group, the diagnostic performance of plasma NGAL, CRP, and NLR was equally substantial and superior to that of NEU and WBC. Within the AP group, plasma NGAL and CRP exhibited comparable diagnostic efficacy, outperforming NEU, WBC, and NLR. When differentiating AA in the non-appendicitis group (ie HC group + AP group), NGAL and CRP demonstrated comparable diagnostic efficacy, surpassing that of NEU, white WBC, and NLR. While the integration of multiple diagnostic tests can potentially improve overall diagnostic accuracy, the observed enhancement in the AUC is not statistically significant. NGAL, CRP, WBC, NEU% and NLR were significantly increased in patients with acute abdomen. NGAL and NEU% may function as independent risk factors for predicting the incidence of AA, with NGAL and CRP demonstrating similar and favorable diagnostic performance. While the combined evaluation of these biomarkers may enhance the diagnostic value for AA, the improvement in the area under the curve (AUC) is not substantial.

DIAGNOSTIC MARKERS IN ACUTE APPENDICITIS: A SYSTEMATIC REVIEW

Introduction: Appendicitis is the most common emergency case of abdominal surgery and requires immediate surgical intervention to avoid serious complications. If appendicitis is treated late, it will increase patient morbidity and mortality. Despite the relatively high incidence of needless appendectomies, ranging from 20% to 30%, such occurrences are deemed tolerable given the substantial reliability of beneficial outcomes.&#x0D; &#x0D; The aim: This article showed diagnostic markers in acute appendicitis.&#x0D; &#x0D; Methods: This study demonstrated compliance with all requirements by comparing itself to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 standards. Therefore, the experts were able to ensure that the study was as current as feasible. For this search strategy, publications published between 2013 and 2023 were considered. Several online reference sources, including Pubmed and SagePub, were utilized for this purpose. It was determined not to consider review pieces, previously published works, or works that were only partially completed.&#x0D; &#x0D; Result: The PubMed database yielded a total of 87 articles in response to our search query, while the search conducted on SagePub resulted in 69 articles. The search conducted for the last year of 2013 resulted in a total of 29 articles found in PubMed and 31 papers found in SagePub. Ultimately, a comprehensive compilation of 22 papers was achieved, with 15 sourced from PubMed and an additional seven obtained via SagePub. We incorporated seven studies that satisfied the established criteria.&#x0D; &#x0D; Conclusion: Study shows that a shift in pain from the epigastrium to the Mc Barney point and heel drop test is a sign of appendicitis based on physical examination. Examination of white blood cells and CRP can be other reliable markers to confirm acute appendicitis.

Diagnostic Value of Inflammatory Markers in Acute Appendicitis

Background: Appendicitis in children is a common surgical emergency and its diagnosis remains challenging. Diagnosisusing blood inflammatory markers is still debatable. The purpose of this study was to determine the effectiveness of bloodinflammatory markers obtained during routine blood tests in diagnosing acute appendicitis in childrenin addition torespondent's demographic data as well. Methods: This was a descriptive cross-sectional study conducted between January 2018 to June 2019 at the Department ofSurgery of Sylhet MAG Osmani Medical College Hospital to determine the value of blood inflammatory markers in thediagnosis of acute appendicitis. The study enrolled 246 patients who underwent surgery for acute appendicitis based onclinical/ultrasonographic diagnosis. Prior to surgery, white blood cell (WBC) count and C-reactive protein (CRP) levels of thepatients were measured, and their sensitivity was analyzed based on histopathological diagnosis. Results: The mean age of the 246 study participants was 28.31±10.12 years. Histological confirmation of acute appendicitiswas obtained in 212 cases. The male-female ratio was 2.21:1 in 212 cases of confirmed appendicitis. WBC counts had asensitivity of 84% and CRP 76% while those were elevated alone. But the sensitivity and specificity increased to 91% and 75%,respectively when both the WBC counts and CRP levels were raised. Conclusion: When only the WBC count or CRP is performed, no additional information can be obtained to help the diagnosisof acute appendicitis. However, the diagnostic sensitivity increases when both WBC count and CRP level are raised. Keywords: Acute appendicitis, Laboratory diagnosis, Children, White blood cell, C-reactive protein

EP.FRI.479 Clinical accuracy of u/sound combined with inflammatory markers in Acute Appendicitis

Abstract Traditionally acute appendicitis has been a clinical diagnosis based on patients' history and physical examination, but the accuracy of clinical diagnosis ranges from 70-95%. Pre-operative diagnosis of acute appendicitis still remains an enigmatic challenge, because no single test alone can reduce the rate of negative appendectomy. Hence some authors have recommended a combination of two or more investigations to increase accuracy and therefore the use of imaging is gaining support. The objective of the study was to determine the clinical accuracy of ultrasound, combined with inflammatory markers such as CRP, WBC, and neutrophilia keeping histopathology as the gold standard. Methods The study was conducted in a Tertiary care hospital in Peshawar from September 2014 to March 2015 on 250 patients who were clinically diagnosed with acute appendicitis. All these patients underwent u/sound scanning in addition to blood tests. Findings In this study, WBC had the highest sensitivity (77.68%) followed by neutrophil% (69.96%), CRP(67.10%), and U/Sound (62.96%) respectively. While U/Sound had the highest specificity (70.59%) followed by CRP and TLC (64.71% each) and neutrophil% (58.82%) respectively. When all the four tests were combined the sensitivity, specificity, (99.17% and 98.45%) increased significantly. When all four tests were negative, appendicitis could be safely ruled out. Conclusion Acute appendicitis is very unlikely and surgery can be safely deferred in these patients when all tests are negative thereby reducing the negative appendicectomy rates.

Evaluation of Hyperbilirubinemia as a New Diagnostic Marker for Acute Appendicitis and its Role in the Prediction of Appendicular Perforation

Evaluation of Hyperbilirubinemia as a New Diagnostic Marker for Acute Appendicitis and its Role in the Prediction of Appendicular Perforation

Role of liver function tests to assess severity of acute appendicitis and predict complications

Background: Acute appendicitis is commonest surgical emergencies of abdomen. Literature shows LFT can be used as a marker of acute appendicitis and may predict severity of appendicitis.Methods: An observational prospective study of 100 cases of acute appendicitis. Study period was from October 2018 to September 2020. Ethical clearance certificate was taken from Institutional ethics Committee. All patients underwent abdominal ultrasound, blood tests including LFT and appendectomy. Histopathology reports were analysed. Patients were divided into 2 groups- inflammatory and complicated appendicitis. Data was collected and statistically analysed using SPSS software version 19.Results: Out of 100 patients 64% are males and 36% females. 4% are negative appendectomies. Total bilirubin elevated in 60% of inflammatory and 89% of complicated appendicitis, p value=0.0053 (significant), sensitivity- 62%. Direct bilirubin elevated in 88% of inflammatory and 96% of complicated appendicitis, p value=0.05 (significant), sensitivity-69%. ALT, AST not raised in both groups. ALP elevated in 81% of inflammatory and 82% of complicated appendicitis with sensitivity-70.5%.Conclusions: LFT can be used to diagnose, assess severity and predict complications of acute appendicitis with elevations of total bilirubin, direct bilirubin and ALP being most useful.

Evaluation of Phospholipase A2 Activity, High Sensitive C- Reactive Protein Level and White Blood Cell Count as Predictive Markers in Acute Appendicitis: Novel Approach

We compared the predictive value of determining group II phospholipase A2 (PLA2) in serum for diagnosing acute appendicitis with the predictive values of white blood cell count (WBC) and measurement of C-reactive protein (CRP). In this prospective study, we included 62 patients who were undergoing appendectomy after clinical diagnoses of acute appendicitis. The performance of each test was measured by receiver-operating characteristic curves. The white blood cell count usually becomes elevated with infection. In early appendicitis, before infection sets in, it can be normal, but most often there is at least a mild elevation even early in the process. Unfortunately, appendicitis is not the only condition that causes elevated white blood cell counts. Background Appendicitis and acute abdominal pain are interrelated; pose to emergency surgical intervention for remedy. Despite of advanced techniques, the chance of appendicular perforation worsening the condition is high. An ideal approach to understand such an emergency scenario is more vital in patient care at health delivery system. Materials and Methods This Prospective study was conducted in 62 patients who have been clinically diagnosed as having acute appendicitis and posted for emergency appendectomy, from December 2016 to 2018. Pre-operatively blood was collected for high sensitive C- reactive protein (hs CRP) and PhospholipaseA2 (PLA2) estimation, after completion of surgical procedure, all specimens were sent for histopathological examination, which were correlated with the results of hs CRP levels and PLA2 activity. Results In present study, males (54.8%) outnumbered females (45.2%). In the study mean age of subjects was 26.77 ± 11.371 years. Majority of them were in the age group 40 years (12.9%). In the study there was positive correlation between hsCRP and PLA2. i.e. with increase in hsCRP, there was increase in PLA2 and vice versa. However the correlation was not statistically significant. Conclusion PLA2 activity appears to be a promising new laboratory parameter for diagnosing acute appendicitis along with clinical examination. Patients with clinical signs and Symptoms of appendicitis and high hs CRP and PLA2 activity should be identified as having a higher probability of appendicular perforation.

Співвідношення нейтрофілів до лімфоцитів як маркер гострого апендициту та його деструктивних форм у дітей

Співвідношення нейтрофілів до лімфоцитів як маркер гострого апендициту та його деструктивних форм у дітей

The coagulation profile as a marker for acute appendicitis in the paediatric population: Retrospective study.

Introduction:Appendicitis is the commonest and most frequently misdiagnosed acute abdominal surgical illness in the paediatric population worldwide. The aim of this study is to evaluate the role of coagulation profile in acute appendicitis (AA) in children.Materials and Methods:we retrospectively collected data of patients submitted to appendectomy from 2011 to 2017. According to histopathology, patients were divided into three groups: not histologically confirmed AA (NAA), simple AA (SAA) and complicated AA (CAA). White blood cell (WBC) count, relative neutrophilia (Neutr%), C-reactive protein (CRP), prothrombin time ratio (PTratio), activated partial thromboplastin time ratio (APTTratio) and fibrinogen (Fib) were compared among groups.Results:Three hundred and seven patients were included: 57 NAA, 184 SAA and 66 CAA. WBC was significantly different among groups: CAA (mean 16.67 × 103/ml), SAA (14.73 × 103/ml, P = 0.01) and NAA (10.85 × 103/ml, P < 0.0001). Significant differences were found for Neutr% (mean CAA 81.14 vs. SAA 77.03 P = 0.006, vs. NAA 63.86 P < 0.0001) and CRP (mean NAA 2.56, SAA 3.26, CAA 11.58, P < 0.0001). PTratio and Fib increased with the severity of AA receiver operator characteristic curves were similar for CRP (0.739), Fib (0.726), WBC (0.746) and Neutr% (0.754), while for PTratio and aPTTratio were 0.634 and 0.441, respectively.Conclusions:extrinsic coagulation pathway is altered in AA, especially in CAA. Coagulation can be useful in the diagnostic and perioperative anaesthetic management of AA in children. Fib seems to have the highest accuracy.

Diagnosis of acute appendicitis and clinical outcomes following laparoscopic surgery: a cohort study.

The clinical assessment of appendicitis remains challenging, especially between genders and across age groups. Negative appendicectomy rates (NARs) can be as high as 43% and are significantly higher in the female population. Evidence suggests blood markers such as white blood cell count (WBC) and C-reactive protein have poor predictive value. There is a lack of regional data assessing workup and outcomes following laparoscopic appendicectomy. A multi-centre, retrospective study was performed. A database of adult patients undergoing laparoscopic appendicectomy at Manly and Mona Vale Hospitals (Sydney, Australia) was analysed with regard to clinical assessment and outcomes. The primary endpoint was histological confirmation of acute appendicitis (AA). Secondary endpoints were length of hospital stay, NAR, correlation between preoperative WBC and AA, and sensitivity of preoperative imaging. A total of 501 patients were included in the study. AA was confirmed in 91.2% of patients. The NAR was 8.8% across all subgroups. The NAR was 12.1% in women. 95.6% of patients had preoperative imaging. There was a statistically significant relationship between WBC and length of stay (P < 0.005), with elevated WBC correlating with increasing length of stay. We concluded that preoperative WBC when elevated can be used as a marker for AA and also as a predictor for length of stay in hospital. We would also advocate the use of preoperative imaging in young women and children.

Diagnostic markers in acute appendicitis

Objective The objective of the study was to determine the value of white cell count (WBC), C-reactive protein (CRP), and bilirubin as diagnostic markers in acute appendicitis. Background Appendicitis is a frequent reason for hospital admissions. Elevated CRP, white blood cell count, and serum bilirubin have been suggested as individual markers for appendicitis and appendicular perforation. Patients and methods This prospective observational study was conducted on patients admitted with clinical suspicion of acute appendicitis at Menoufia University and Bolak El-Dakror Hospitals in the 6 months period starting from June 2017 involving 150 patients. Results A total of 150 patients were operated under suspicion of appendicitis. From these, 65.3% of patients had simple appendicitis, 18.7% had normal appendix, and 16% of patients had complicated appendicitis. Complicated appendicitis was accompanied with higher WBC level with significant correlation (P = 0.03); complicated and simple ones were accompanied with a higher level of total bilirubin than normal appendix with significant differences (P Conclusion Combining blood markers was useful in predicting appendicitis and perforated appendicitis, in addition to CRP and WBC, and blood levels of bilirubin.

Діагностичні резерви деталізації гострого апендициту у вагітних

Мета роботи: встановити додаткові діагностичні критерії діагностики гострого апендициту у вагітних для оптимізації лікування даної патології.Матеріали і методи. В період із 2004 до 2012 р. у хірургічне відділення міської клінічної лікарні № 1, № 3 м. Києва було госпіталізовано 864 вагітні жінки, які були розділені на досліджувану (n=473) та контрольну (n=391) групи. Найчастіше зустрічався ГА – 258 (29,8 %) від усіх випадків госпіталізації. В процесі обстеження поряд із загальноприйнятими дослідженнями вивчалися гематологічні, цитологічні та імунологічні показники у вагітних із діагнозом гострий апендицит. Для оцінки патогенетичних механізмів формування запальної реакції у вагітних досліджуваної групи, а також для можливості проведення диференційної діагностики та проведення раннього прогнозування ускладнень проводили дослідження активності функціонування неспецифічної резистентності та імунологічної реактивності: НСТ-тест, визначення рівнів Ig M, Ig G, Ig E, Ig A, ПРК (прокальцитоніну), Il β-1, ФНП (фактор некрозу пухлини).Результати досліджень та їх обговорення. При проведенні біохімічних досліджень для встановлення типових додаткових маркерів ГА у вагітних ми встановили, що у пацієнтів спостерігаються ознаки розвитку ендотоксикозу, пов’язані з накопиченням токсинів мікробного походження (ТЗН), декомпенсацією функціональної активності фагоцитуючих клітин – нейтрофільних гранулоцитів (індекс стимуляції) та токсинозв’язуючої та біосентизуючої здатності печінки, коефіцієнт де Рітіса, наявність кріоглобулінів. При цьому встановлено, що у пацієнтів другої клінічною групи дані тенденції були більш виразні. Визначено, що у пацієнтів обох клінічних груп проявляють такі ознаки запальної відповіді, як підвищення концентрації основних запальних медіаторів – Іл-1 та ФНП відносно значень здорових осіб. Встановлено, що в другій основній клінічній групі данні зміни були більш виразні, що свідчить про значну активність запальних реакцій. При цьому компенсуюча дія протизапальних медіаторів була знижена, що може бути причиною декомпенсованої реакції та причиною розвитку ризику системної запальної відповіді.

Hematological Diagnostic Markers of Acute Appendicitis in Children

White blood cell (WBC) and platelet indices are useful biomarkers in many inflammatory diseases. A study was made of possible WBC and platelet indices in children with acute appendicitis. We reviewed the results of the complete blood count tests made on admission of 150 children with acute appendicitis (94 boys, 56 girls) and those of 74 healthy children (46 boys, 28 girls). We compared the WBC and platelet indices between the children with acute appendicitis and healthy children and between the complicated and uncomplicated cases of appendicitis. The children with acute appendicitis had higher WBC, neutrophil count, neutrophil percentage and neutrophil/ lymphocyte ratio and lower lymphocyte count and lymphocyte percentage than the healthy children. Cases of appendicitis with complications had lower lymphocyte count, lymphocyte percentage and higher neutrophil to lymphocyte ratio than those without complications. In girls WBC, neutrophil count and neutrophil percentage were higher in complicated acute appendicitis. WBC, neutrophil count, neutrophil percentage, lymphocyte percentage and a neutrophil/lymphocyte ratio >2.5 were accurate markers for acute appendicitis in children, but not for detecting complicated cases. Girls with acute appendicitis had lower platelet distribution width than healthy girls, with high sensitivity and positive predictive value at platelet distribution width <12.4%, but moderate specificity and negative predictive value. The Neutrophil/lymphocyte ratio can be used as an additional diagnostic marker of acute appendicitis in children, but cannot detect complications, and platelet distribution width can be an additional marker for confirming, but not excluding, acute appendicitis in girls.

Prospective Assessment of Elevated Serum Bilirubin Level in Diagnosis of Acute Appendicitis

Background: The rate of misdiagnosis of appendicitis has remained constant, despite the advance in diagnostic modalities. So, the search for a reliable marker is necessary. The aim of this study was to determine the value of hyperbilirubinemia as a marker for acute appendicitis. Patients and Methods: This prospective study was carried out during the period from April 2014 till April 2017 and included 369 patients presented with right iliac fossa pain diagnosed clinically as acute appendicitis and submitted to appendectomy (open or laparoscopic). Demographic data, data of clinical examination, radiological and laboratory investigations (specifically, complete blood count (CBC), C- reactive protein (CRP) and total serum bilirubin) were collected. Then appendectomy was done, the removed appendices were sent for histopathological examination. Patients were divided into three groups: group (I) histopathologically normal appendix, group (II) simple appendicitis and group (III) Complicated appendicitis. The data of the three groups were analyzed and compared. Results: This study included 369 patiens, 195 (52.8%) are males. Mean age was 22.6 ±7.22 years. Open appendectomy was performed in 306 (91.2%) patients and laparoscopic in 63 (8.8%). Histopathological examination revealed normal appendix in 69 (18.6%) patients, simple appendicitis in 240 (65.0%) and complicated appendicitis in 60 (16.2%). The serum total bilirubin had a higher specificity (87%) compared with white blood cells (WBC) (70%) and CRP (65%), but a lower sensitivity (28% vs. 66% and 58%, respectively) for acute appendicitis versus normal appendix group and a higher specificity (80%) than both WBC (35%) and CRP (45%), but a lower sensitivity than WBC and CRP (60% vs. 70% and 70% respectively) for complicated appendicitis versus simple appendicitis. Conclusion: Hyperbilirubinemia is a significant predictor in diagnosis of acute appendicitis in cases of right iliac fossa pain. It is also a significant predictor of complication (perforation and gangrene) in cases of acute appendicitis.

Hyperbilirubinemia is a New Dignostic Marker for Acute Appendicitis and its Role in Prediction of Complicated Appendicitis

Hyperbilirubinemia is a New Dignostic Marker for Acute Appendicitis and its Role in Prediction of Complicated Appendicitis

Validity of Serum Total Bilirubin as a Diagnostic Tool for Acute Appendicitis

Objective: To study the relationship between hyperbilirubinemia and acute appendicitis and to evaluate its credibility as a diagnostic marker for acute appendicitis and to evaluate whether elevated serum total bilirubin levels have a predictive potential for the diagnosis of complicated appendicitis Background: In acute appendicitis occurs through bacterial invasion in appendix leads to transmigration of bacteria and release of TNF-alpha, IL6 and cytokines. These reach the liver through superior mesenteric vein and may produce inflammation or dysfunction of liver either directly or indirectly by altering hepatic blood flow with rising of total serum bilirubin. Methods: This is a prospective cohort study including Ninety four (94) of adult patients have right iliac fossa pain attending to the Emergency Department (ED) at Suez Canal university Hospital. All 94 patients undergo total serum bilirubin measuring and post-operative histopathological examination of removed appendix. Results: In this study population of 94 patients and found that thirty-six male patient (38 %) and fifty-eight female patient (62 %), 81 patients (86.2%) were diagnosed as acute appendicitis while 13 patients (13.8%) were normal post-operatively by histopathological reports. Amongst the patients diagnosed with Acute appendicitis post-operatively, 57 patients (70.4%) were found to have elevated serum total bilirubin (>1.2mg/dL) while 24 patients (29.6%) had normal serum total bilirubin levels (≤1.2 mg/dL). Conclusion: Serum total bilirubin level appears to be a promising new laboratory marker for diagnosing acute appendicitis and have a predictive potential for the diagnosis of complicated appendicitis.

Evaluation of hyperbilirubinaemia as a new diagnostic marker for acute appendicitis &amp; its role in prediction of appendicular perforation

Introduction: Acute appendicitis is the most common general surgical emergency and early surgical intervention improves outcomes. The diagnosis of appendicitis can be elusive, and a high index of suspicion is important in preventing serious complications from this disease. The present study was undertaken to assess relationship between hyperbilirubinemia and acute appendicitis to evaluate its credibility as a diagnostic marker for acute appendicitis. Material & methods: The case control study was carried out on 60 patients who were clinically diagnosed as having acute/perforated appendicitis and on 60 healthy volunteers from the community having no signs and symptoms of acute appendicitis. The evaluation of acute appendicitis was done by history taking ,clinical examination and investigations including CBC, Ultrasonography and confirmed by histopathological examination of appendicectomy specimen. For the final analysis various statistical methods like descriptive, crosstabs, chi-square test were applied using the SPSS (version 20.0). Results: Total serum bilirubin level was raised in 43 patients (71.7%) out of the total sample of 60 cases. Of these, 42(70%) cases were positive for appendicitis on HPE (True Positive), and 1(1.7%) was negative on HPE (false positive). Among the 17(28.3%) cases in whom serum bilirubin was not raised, in 3(5%) cases HPE was negative (True Negative), and in 14 (23.3%) cases HPE was positive (False Negative). In 60 healthy individuals mean serum bilirubin was 0.7±0.3 mg%. In 46 cases of histopathologically proved acute appendicitis (non-perforated) the mean serum bilirubin was 1.3±7mg% while in perforated group it was 2.5±1.1mg% (P value was significant i.e. <0.001). Conclusion: Serum bilirubin is an important adjunct in diagnosing the presence of gangrenous/perforated appendicitis. Our findings confirm that hyperbilirubinaemia has a high specificity for distinguishing acute appendicitis.

Liver function test as a marker for acute appendicitis

Background and Objectives: Acute appendicitis is one of the commonest surgical emergencies of the abdomen worldwide. Even with the availability of current imaging investigation like USG , CT scan and MRI, the diagnosis is still a problem. Delay in diagnosis increases mortality and morbidity. Liver function test is one of the biochemical parameters being assessed as a marker of acute appendicitis and may also predict the severity of the inflammation. However the available literature is limited and views are conflicting. In this study, it is proposed to access the validity of using liver function test to predict the appendicitis and its severity.Material and Methods: This is a prospective study of 80 cases of operated patients of acute appendicitis in Universal College Of Medical Sciences, Bhairahawa, Nepal during the period from 6th May 2013 to 6th July 2014. Data were collected from the patient by their clinical history, examination and investigations, Liver function test and ultrasound. Post operative follow up was done to note for complications and histopathology findings. Data collection was compiled in a systemic way in preformed proforma and analyzed.Results: Out of 80 patients, 44(55%) were male and 36(45%) were female. Total serum bilirubin was elevated in 29 (36.25%) of the patients. Rise in serum bilirubin was mixed type with direct bilirubin Predominance. In Liver enzymes ALT, AST, ALP were raised in 32.5%, 28.75% and 82.5% respectively. Hyperbilirubinemia has the specificity (80 %) sensitivity (37.33%) with good positive predictive value of 96.55%. Similarly sensitivity and specificity of direct bilirubin (90.67%, 20.00%), Indirect bilirubin (16.00%, 80%), AST/SGOT (30.67%, 100%), ALT/SGPT (34.67%, 100%) ALP (84.00%, 40%) respectively. The positive predictive value for direct bilirubin, indirect bilirubin, AST/SGOT, ALT/SGPT and ALP are 94.44%,92.31%,100%,100% and 95.45% respectively.Conclusion: Liver function test is a marker for acute appendicitis and its complication with a good positive predictive value. Liver function test should be used together with clinical examination and other laboratory investigations in the assessment of patients with suspected acute Appendicitis.Janaki Medical College Journal of Medical Sciences (2015) Vol. 3 (1):31-36

Diagnostic value of procalcitonin for acute complicated appendicitis.

A rapid and reliable test for detection of complicated appendicitis would be useful when deciding whether emergency surgery is required. We investigated the clinical usefulness of procalcitonin for identifying acute complicated appendicitis. We retrospectively analyzed 63 patients aged ≥15 years who underwent appendectomy without receiving antibiotics before admission and had preoperative data on the plasma procalcitonin level (PCT), body temperature (BT), white blood cell count (WBC), neutrophil / lymphocyte ratio (N/L ratio), and C-reactive protein level (CRP). Patients were classified into 3 groups: group A (inflammatory cell infiltration of the appendix with intact mural architecture), group B (inflammatory cell infiltration with destruction of mural architecture, but without abscess or perforation), and group C (macroscopic abscess and/or perforation). For identifying destruction of mural architecture, the diagnostic accuracy of PCT was similar to that of BT or CRP. However, the diagnostic accuracy of PCT was highest among the five inflammatory indices for identifying abscess and/or perforation, with the positive predictive value of PCT for abscess and/or perforation being higher than that of CRP (73% vs. 48%). Univariate analysis of the predictors of abscess and/or perforation revealed that a plasma PCT level ≥0.46 ng/mL had the highest odds ratio (30.3 [95% confidence interval: 6.5-140.5] versus PCT <0.46 ng/mL). These findings indicate that procalcitonin is a useful marker of acute appendicitis with abscess and/or perforation.

Ischemia-modified albumin must be evaluated as an oxidative stress marker together with albumin and bilirubin in individuals with acute appendicitis

Ischemia-modified albumin must be evaluated as an oxidative stress marker together with albumin and bilirubin in individuals with acute appendicitis