Diagnostic Value of D-Dimer Combined with WBC Count, Neutrophil Percentage and CRP in Differentiating Between Simple...

Acute appendicitis is the most common surgical emergency in pediatrics. In this study, we aimed to evaluate the diagnostic value of D-dimer in differentiating between simple and other severe acute appendicitis in children combined with white blood cell (WBC) count, neutrophil percentage, and C-reactive protein (CRP).

A retrospective study enrolled 327 consecutive patients who underwent appendectomy for acute appendicitis (aged 13 days to 14 years) in Qingdao Women & Children's Hospital from Jan 2013 to Dec 2014. WBC count, neutrophil percentage, CRP, and D-dimer levels were measured. Descriptive analyses, Student's t-test, and receiver operating characteristic (ROC) analyses were used to quantify the correlation between D-dimer level and the severity of appendicitis and to evaluate the differential diagnostic value of D-dimer combined with WBC count, neutrophil percentage and CRP between simple and other severe appendicitis.

Compared with simple appendicitis, WBC count, neutrophil percentage, CRP, and D-dimer levels were all significantly higher in other severe appendicitis (p < 0.01). Both CRP and D-dimer levels were positively correlated with the severity of disease. In differentiating between simple and other severe appendicitis, CRP (area under the ROC curve (AUC): 0.841) showed the highest sensitivity (80.7%) and the highest negative predictive value (NPV) (60.0%), while D-dimer (AUC: 0.793) showed the highest specificity (90.0%) and the highest positive predictive value (PPV) (94.9%). Combined CRP and D-dimer had a sensitivity, specificity, PPV, NPV, and accuracy of 87.5%, 94.6%, 97.8%, 72.9%, and 89.4%, respectively.

CRP and D-dimer levels are positively correlated with the severity of acute appendicitis in children. Combined CRP and D-dimer are identified as suitable diagnostic markers for differentiating between simple and other severe appendicitis, which will provide important guidance for clinicians to determine the follow-up management of acute appendicitis.