Diagnostic value of C-reactive protein and neutrophil-limphocyte ratio in perforated appendicitis at Hasan Sadikin Hospital Bandung

Abstract

Background: The diagnosis of appendicitis depends on the subjective criteria of clinical examination. However, distinguishing acute perforated appendicitis (local peritonitis) and non-perforated is often difficult especially in the elderly population that usually not clinically specific unless it has developed into generalized peritonitis. Between the non-perforated acute appendicitis and perforate should be distinguished because of different surgical approaches. C-reactive protein (CRP) and neutrophil-lymphocyte ratios are known to be associated with various conditions such as malignancy, heart disease, and inflammation, including acute perforated appendicitis. This examination not only is cheaper, but also feasible and available in peripheral hospitals compared to other supports such as ultrasound or CT scan, but this examination has not been routinely used so the purpose of this study is to examine the diagnostic accuracy of both laboratory parameters so as to assist a surgeon to determine whether the case of appendicitis has been perforated or not and can provide information to patients and the families about the diseases and surgical techniques to be performed.Methods: This study used cross sectional analytic in two groups, appendicitis with and without perforation group to know the value of sensitivity, specificity, positive predictor value, negative predictor value, from CRP and RNL in both groups.Results: Of the 46 patients who met the inclusion criteria, the mean age of patients with perforated appendicitis was 33.73±17.101, male sex counted 26 patients (56.5%) and women 20 patients (43.5%). Based on ROC curve analysis, CRP = 76,65 and RNL = 8,825 were obtained, and sensitivity, specificity, positive guess, negative prediction and accuracy value for CRP were 88.0%, 71.4%, 78 %, 5%, 83.3% and 80.4%; While for RNL of 64.0%, 80.9%, 80.0%, NDN, and 71.7%.Conclusions: CRP and RNL have a strong diagnostic value and is moderately strong in cases of perforated appendicitis.

A Cross-Sectional Study of Neutrophil-to-Lymphocyte Ratio in Diagnosing Acute Appendicitis in Hospital Melaka

“…It showed that NLR increased in appendicitis and further increases as the inflammation progresses. This result is consistent with the findings of previous studies (12, 24, 25). Although TWBC showed a significant association with appendicitis, NLR proved superior and has greater diagnostic accuracy compared to TWBC alone (16, 26, 27).…”

Single-Center Retrospective Analysis of Neutrophil, Monocyte, and Platelet to Lymphocyte Ratios as Predictors of Complicated Appendicitis

“…NLR was shown to be elevated in appendicitis, and this elevation continued as inflammation worsened. This finding agrees with those of past research [ 19 , 20 ]. Despite the apparent correlation between WBC and appendicitis, NLR has been shown to be greater and to have higher diagnostic accuracy than WBC solely [ 21 ], and this is reinforced in this study.…”

Predictive value of serum sodium level in determining perforated appendicitis

“…There are studies reporting different results and cut-off values on the diagnostic value of inflammatory markers such as leukocytes, neutrophils, and CRP measured from blood. [14][15][16] In a study conducted by Yang et al [17] perforated AA, both WBC counts and CRP levels were found to be significantly higher than non-perforated AA in patients with perforated AA. Similarly, Guraya et al [18] also found significantly higher WBC values in complex (gangrenous, perforated) appendicitis compared to AA.…”