Combined Diagnostic Accuracy of Total Leukocyte Count, Neutrophil Count, and Ultrasonography for the Diagnosis of Acute Appendicitis

Fatima, Shehzadi Rimsha; Zaheer, Farhan; Moosa, Foad Ali; Arqam, Shehanshah Muhammed; Mussab, Raja Muhammad; Choudhry, Muhammad

doi:10.7759/cureus.13086

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…The NEU count highlights the active and ongoing inflammatory state, while the LYM count highlights the regulatory pathway [15]. According to [16]. The AUC of NLR (0.81) was determined to be lower in our study than in the literature.…”

Section: Discussionmentioning

confidence: 52%

“…According to Hajibandeh et al, NLR is a promising marker that can predict the diagnosis and severity of AA with a cutoff value of 4.7, AUC of 0.96, sensitivity of 88.89%, and specificity of 90.91% [ 4 ]. Fatima et al calculated the sensitivity of the NUE test as 88.03% and specificity as 92.86% in the diagnosis of AA (AUC 0.904) [ 16 ]. The AUC of NLR (0.81) was determined to be lower in our study than in the literature.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

Duyan¹,

VURAL²

2022

Cureus

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BackgroundAcute appendicitis (AA) is one of the most frequent causes of abdominal pain requiring emergency intervention in adults. Approximately one-third of cases present with atypical clinical symptoms. This study aims to compare the monocyte-to-lymphocyte ratio (MLR), red cell distribution width (RDW) to lymphocyte ratio (RLR), and systemic immune inflammation index (SII) with other biomarkers in distinguishing patients with and without AA. MethodologyA total of 347 patients (AA 125, nonspecific abdominal pain 90, and control group 132) were enrolled in the study according to the cross-sectional study design. Receiver operating characteristic (ROC) analysis was used to determine the cutoff in diagnostic value measurements. Statistical significance was determined by the statistics of sensitivity, specificity, positive predictive value, and negative predictive value. Comparison of ROC curves of C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), neutrophil-tolymphocyte ratio (NLR), MLR, and SII was evaluated with the pairwise comparison of ROC curves and 95% confidence interval. ResultsIn detecting AA, CRP, WBC, NEU, NLR, MLR, and SII have excellent diagnostic power (area under the curve [AUC] 0.80-0.88), while RDW, lymphocyte count, monocyte (MON) count, and RLR had acceptable diagnostic power (AUC 0.70-0.77). When the power in the diagnosis of AA was compared, a significant difference was found between CRP and NEU, CRP and SII, WBC and NEU, and WBC and SII. ConclusionsThe diagnosis of AA remains dependent on many factors. Inflammatory biomarkers assist this process. MLR and SII may be recommended to use in diagnosing AA in adults, along with other clinical findings. RLR is adequate but not superior.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

Duyan¹,

VURAL²

2022

Cureus

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“…WBC is commonly used for confirming any suspected inflammation or infection in the body. Fatima et al, in 2021, revealed that the accuracy of total leucocyte count > 11,000/mm 3 (as a diagnostic tool) was found to be 82.94%, with sensitivity and specificity being 83.10% and 82.14%, respectively [ 6 ]. A study conducted in India by Shafi et al in 2009 showed the sensitivity and specificity of WBC as 97.82% and 55.55%, respectively [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

WBC Count vs. CRP Level in Laboratory Markers and USG vs. CT Abdomen in Imaging Modalities: A Retrospective Study in the United Arab Emirates to Determine Which Are the Better Diagnostic Tools for Acute Appendicitis

Shahul Hameed,

Rafi Ahamed

et al. 2023

Cureus

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Introduction Acute Appendicitis (AA) is the most common surgical emergency. Despite the use of various diagnostic parameters, the rate of negative appendectomy remains high (30%). Thus, through our retrospective study, we aim to analyse whether white blood cell (WBC) count or C-reactive protein (CRP) level is more indicative in the confirmation of AA. We also analysed imaging modalities ultrasonography (USG) and computed tomography (CT) of the abdomen to find out which is better for diagnosing AA. Methods Patients with suspected AA admitted for laparoscopic appendectomy in Saqr Hospital, Ras Al Khaimah, United Arab Emirates, during 2019-2020 were included in the study. Patients who had either or both WBC and CRP values were included in the study and their diagnosis was confirmed based on histological appendectomy findings. Data analysis was done using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States), receiver operating characteristic (ROC) curve, and chi-square test as required. p-value of <0.05 was considered statistically significant. Results Out of the 320 patients with suspected AA, WBC had a p-value of 0.8 (insignificant). A total of 228 patients who had elevated WBC had confirmed histological diagnosis of AA, and 152 patients who were tested for CRP and had elevated levels had confirmed histological diagnosis of AA. CRP had a p-value of 0.04 (significant). However, when the ROC curve was used as evidence to see which was a better test, WBC and CRP both had a low area under the curve (AUC), which proved that they were not the most accurate diagnostic marker in diagnosing AA. However, CRP was slightly better than WBC. A total of 266 patients underwent USG abdomen and it had a p-value of 0.4 (insignificant), while 118 patients underwent CT scan, which had a p-value of 0.01 (significant). CT abdomen was statistically proven as a better radiological investigation. Also, when the ROC curve was used to compare USG and CT abdomen, CT again proved to be a better radio diagnostic method for AA. Conclusions From our study, it can be concluded that CRP is better than WBC in ruling in appendicitis and CT abdomen is better than USG in diagnosing appendicitis, but CT abdomen is only next to histological diagnosis in confirming AA. Hence, we recommend doing CRP as the primary laboratory marker for suspected cases of AA. CT abdomen is the ideal imaging modality in cases of suspected AA where clinical examination, laboratory values, and ultrasound examination are inconclusive.

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“…These highly sophisticated markers are difficult to apply in clinical practice but the raise of neutrophil count in peripheral blood may be regarded as simplified method for monitoring of neutrophils activation. Although neutrophils activation can be measured by released cytokines, simple measurement of neutrophil counts derangements in peripheral blood count analysis was proposed as a sufficient marker of inflammation [ 103 , 104 , 105 ], easy to obtain and repetitive.…”

Section: Neutrophil To Lymphocyte Ratio (Nlr)mentioning

confidence: 99%

The Significance of Simple Inflammatory Markers in Off Pump Surgery—Review

Urbanowicz¹,

Olasińska-Wiśniewska²,

Gładki³

et al. 2022

Rev. Cardiovasc. Med.

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The inflammatory background of coronary artery disease is gaining more attention in recent times. Off pump surgery is minimally invasive type of surgical revascularization with relatively low number of applications in cardiac surgery centers worldwide that allows for perioperative inflammatory reactions minimalization. The simple inflammatory markers (neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelets to lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammatory response index (SIRI), aggregate index of systemic inflammation (AISI)) possess a clinically significant impact on patients' prognosis and may help to improve patients' long-term results. The review presents the current knowledge regarding their utility in clinical practice. Assessment of inflammatory indices obtained from whole blood count analysis allows to indicate those patients who need scrupulous follow-up due to predicted worse long-term survival. Perioperative measurement and analysis of simple whole blood counts is inexpensive and easily available and may improve the results of surgical revascularization by better identification of patients at higher risk of worse outcomes.

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Combined Diagnostic Accuracy of Total Leukocyte Count, Neutrophil Count, and Ultrasonography for the Diagnosis of Acute Appendicitis

Cited by 6 publications

References 16 publications

Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

WBC Count vs. CRP Level in Laboratory Markers and USG vs. CT Abdomen in Imaging Modalities: A Retrospective Study in the United Arab Emirates to Determine Which Are the Better Diagnostic Tools for Acute Appendicitis

The Significance of Simple Inflammatory Markers in Off Pump Surgery—Review

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