Effectiveness of pre-operative routine blood tests in predicting complicated acute appendicitis

Area of Science:

• Surgical pathology
• Diagnostic laboratory medicine
• Clinical biochemistry

Background:

• Early prediction and diagnosis of perforated appendicitis are crucial for optimal surgical management.
• Pre-operative laboratory tests are routinely performed and may offer predictive value for complicated appendicitis.

Purpose of the Study:

• To evaluate the role of routine pre-operative laboratory examinations in predicting complicated acute appendicitis, specifically perforation.

Main Methods:

• Retrospective analysis of 783 patients operated for acute appendicitis between 2014 and 2019.
• Comparison of pre-operative laboratory parameters including leukocyte (WBC), neutrophil, lymphocyte, platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP), and neutrophil-to-lymphocyte rate (NLR) between non-perforated and perforated appendicitis groups.
• Statistical analysis to identify significant differences and predictive cutoff values.

Main Results:

• Of 702 patients with appendicitis, 89.9% were non-perforated and 10.1% were perforated.
• Perforation rate was significantly higher in elderly patients.
• Significantly lower lymphocyte counts and significantly higher C-reactive protein (CRP) and neutrophil-to-lymphocyte rate (NLR) were observed in the perforated group.
• Established cutoff values for CRP (44.0 mg/dL), NLR (7.65), and lymphocytes (1.7/mm3) for diagnosing perforated appendicitis.
• No significant difference in WBC, neutrophil, PLT, MPV, and PDW values between the groups.

Conclusions:

• Low lymphocyte count, elevated CRP, and elevated NLR are reliable and strong predictive parameters for diagnosing complicated (perforated) acute appendicitis.
• These laboratory markers can aid in the early identification of patients at higher risk for perforation.