Diagnostic value of laboratory parameters for complicated appendicitis: A two‑center study

Area of Science:

• Medical diagnostics
• Surgical pathology
• Laboratory medicine

Background:

• Acute appendicitis (AA) treatment varies, with surgery for complex cases and antibiotics for uncomplicated ones.
• Distinguishing between complex and uncomplicated appendicitis pre-operatively remains a challenge.
• Accurate pre-surgical differentiation is crucial for appropriate treatment selection and patient outcomes.

Purpose of the Study:

• To evaluate the effectiveness of laboratory parameters in diagnosing complicated appendicitis.
• To identify specific laboratory markers that can predict appendicitis complexity.
• To establish cut-off values for significant parameters to aid in clinical decision-making.

Main Methods:

• Retrospective analysis of 1,514 acute appendicitis cases from two Beijing hospitals (January 2016 - September 2021).
• Cases were classified into uncomplicated and complicated appendicitis groups.
• Uni- and multivariate logistic regression and ROC curve analysis were employed to identify significant diagnostic parameters.

Main Results:

• Significant differences were observed in age, body temperature, white blood cell count, C-reactive protein (CRP), neutrophil count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet count, red blood cell distribution width (RDW-CV and RDW-SD), mean platelet volume (MPV), and direct bilirubin between groups.
• Independent predictors for complicated appendicitis included CRP, neutrophil count, NLR, PLR, platelet count, RDW-CV, RDW-SD, MPV, and direct bilirubin.
• Specific cut-off values identified: CRP >22.95 mg/l, NLR >5.7, serum direct bilirubin >6.1 mmol/l, and RDW-SD >17.7 fl were significantly associated with complicated appendicitis.

Conclusions:

• Laboratory parameters, particularly CRP, NLR, direct bilirubin, and RDW-SD, can effectively aid in distinguishing complicated from uncomplicated appendicitis.
• These findings offer valuable tools for pre-operative assessment, potentially guiding treatment strategies.
• Further prospective studies are warranted to validate these diagnostic markers in clinical practice.