Association of Clinical and Laboratory Parameters with Appendiceal Neoplasms in Acute Appendicitis: A...

Background and Objectives: Appendiceal neoplasms are frequently incidental findings in post-appendectomy histopathology, occurring in approximately 0.7-2.5% of patients with acute appendicitis. This study aimed to evaluate the association between clinical and laboratory parameters and the presence of appendiceal neoplasms in patients presenting with acute appendicitis. Materials and Methods: A retrospective cohort study was conducted, including patients treated at the University Medical Center Ljubljana between 2016 and 2020. Inclusion criteria were patients diagnosed with acute appendicitis who underwent emergency appendectomy, while patients with preoperatively diagnosed appendiceal neoplasms or non-surgical management were excluded. Patients with histopathologically confirmed appendiceal neoplasms were compared with a sample of patients without neoplasms, selected from the same cohort. Logistic regression analysis was performed to assess associations between clinical variables (age, sex, duration of symptoms, CRP, and leukocyte count) and neoplasm presence. Results: Appendiceal neoplasms were identified in 48 patients, corresponding to an analytic prevalence of 4.5% (48 of 1030) and a true prevalence of 1.6% (48 of 3014) among all appendicitis cases. In univariate analysis, age, duration of symptoms, CRP levels, and leukocyte count were significantly associated with neoplasm presence. In multiple logistic regression, higher CRP levels (OR 1.04, 95% CI 1.01-1.08; p = 0.007, per 10 mg/L increase) and lower leukocyte counts (OR 0.91, 95% CI 0.85-0.98, p = 0.012) remained significantly associated with appendiceal neoplasms. ROC analysis demonstrated limited discriminative performance (AUC < 0.70 for both parameters). Conclusions: Elevated CRP levels and lower leukocyte counts were associated with appendiceal neoplasms in patients presenting with acute appendicitis, suggesting a distinct inflammatory profile; however, their clinical utility for preoperative identification appears limited.