Predictive biomarkers for complicated acute appendicitis: A prospective Ecuadorian study

Area of Science:

• Medical diagnostics
• Surgical pathology
• Biomarker research

Background:

• Acute appendicitis is a common surgical emergency.
• Complicated acute appendicitis (CAA) and perforated appendicitis (PA) require prompt intervention.
• Accurate pre-operative prediction of appendicitis severity is crucial for patient management.

Purpose of the Study:

• To evaluate the efficacy of established biomarkers in predicting complicated acute appendicitis (CAA) and perforated appendicitis (PA).
• To identify reliable pre-operative indicators for appendicitis severity.

Main Methods:

• An observational, analytic, cross-sectional, prospective study was conducted.
• Evaluated biomarkers included white blood cells, neutrophil percentage (N%), neutrophil-to-lymphocyte ratio, glucose, total bilirubin, C-reactive protein, and procalcitonin (PCT).
• Statistical analysis involved receiver operating characteristic (AUROC) curve estimation, Youden's index for cutoff points, and calculation of sensitivity, specificity, PPV, and NPV.

Main Results:

• Neutrophil percentage (N%) and procalcitonin (PCT) demonstrated significant predictive value for CAA and PA.
• N% > 78.1% showed high sensitivity (82%) and specificity (62%) for CAA, with an AUROC of 78%.
• PCT > 0.14 ng/dL showed high specificity (79%) and PPV (80%) for CAA, with an AUROC of 80%.

Conclusions:

• Neutrophil percentage (N%) and procalcitonin (PCT) are effective pre-operative biomarkers for identifying complicated appendicitis.
• These biomarkers are particularly useful for ruling out perforated appendicitis (PA) when acute appendicitis is suspected.