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Are serum inflammatory markers age dependent in acute appendicitis?
H Paajanen1, A Mansikka, M Laato
1Department of Surgery, Kuopio University Hospital, Finland.
Journal of the American College of Surgeons
|March 1, 1997
Summary
Diagnosing appendicitis in elderly and young patients is challenging due to age-related changes in inflammatory markers. White cell count is a more reliable indicator than C-reactive protein, except in infants.
Area of Science:
- Medical diagnostics
- Pediatric surgery
- Geriatric medicine
Background:
- Preoperative inflammatory markers aid appendectomy decisions, but aging may affect diagnosis.
- Appendicitis diagnosis can be difficult in very young and elderly patients.
Purpose of the Study:
- To evaluate the diagnostic accuracy of white cell count and C-reactive protein for appendicitis across different age groups.
- To determine the impact of aging on the reliability of these inflammatory markers.
Main Methods:
- Analyzed data from 600 patients undergoing appendectomy, stratified by age (0-5, 6-19, 20-39, 40-59, 60-79, >80 years).
- Calculated sensitivity, specificity, diagnostic accuracy, and ROC curves for white cell count and C-reactive protein.
- Compared marker performance across age cohorts.
Main Results:
- Negative explorations and perforations were highest at the extremes of age.
- White cell count outperformed C-reactive protein in diagnosing uncomplicated appendicitis in most age groups, except infants.
- C-reactive protein levels were similarly elevated in perforated appendicitis across ages, but ROC curves showed white cell count was superior except in infants and octogenarians.
Conclusions:
- Leukocyte response diminishes in children aged 0-5 with appendicitis.
- C-reactive protein response remains preserved in appendicitis across other age groups, although white cell count demonstrates better diagnostic accuracy in most.
- Diagnostic accuracy of inflammatory markers for appendicitis varies significantly with age.