Diagnostic value of laboratory results in children with acute appendicitis

Abstract

BackgroundThe correct diagnosis rate in acute appendicitis (AA) is between 72 and 94% despite advanced laboratory and radiologic examinations. This study was conducted to determine the effectiveness of laboratory parameters in the diagnosis of children with appendicitis.Materials and methodsPatients who underwent appendectomy were divided as AA (subdivided into two groups as perforated and non-perforated) and without appendicitis. White blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), red cell distribution (RDW), mean platelet volume (MPV), C-reactive protein (CRP), procalcitonin levels and Alvarado score were recorded.ResultsWBC, NLR and CRP levels were higher in patients with AA (p<0.05). According to the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), p values and 95% confidence interval in predicting patients with and without appendicitis were NLR: 0.703, 0.025, 0.523–0.884; CRP: 0.822, <0.001, 0.725–0.919; procalcitonin: 0.631, 0.150, 506–0.755 and Alvarado score: 0.754, 0.05, 0.578–0.930, respectively. RDW, CRP and procalcitonin values of perforated appendicitis patients were higher compared with those of the non-perforated ones (p<0.05). According to the ROC curve, AUC, p values and 95%CI were NLR: 0.583, 0.094, 0.488–0.678; RDW: 0.715, <0.001, 0.628–0.802; CRP: 0.900, <0.001, 0.842–0.958; procalcitonin: 0.865, <0.001, 0.799–0.930 and Alvarado score: 0.727, <0.001, 0.641–0.812, respectively.ConclusionsCRP is the most effective bioindicator in the diagnosis of AA, the detection of perforated cases. It was revealed that NLR is effective in the diagnosis of AA, procalcitonin and RDW values are effective in the separation of perforated cases.

Utility of Red Cell Distribution Width (RDW) as a Noninvasive Biomarker for the Diagnosis of Acute Appendicitis: A Systematic Review and Meta-Analysis of 5222 Cases

“…Pooling the data (Figure 2) using the random effects model demonstrated no statistically significant difference in the RDW values (WMD = 0.03, 95% CI = (−0.46, 0.52), and p = 0.91) between AA and healthy controls. This outcome was reported by 11 studies [3,30,32,[37][38][39][40]42,43,46,47]. The RDW values of 2590 patients with AA and 983 non-AA cases were compared.…”

“…One of them did not mention the RDW values and was further excluded. Finally, fifteen studies were included in the final meta-analysis [3,[30][31][32][37][38][39][40][41][42][43][44][45].…”

Mean Platelet Volume in the Diagnosis of Acute Appendicitis in the Pediatric Population: A Systematic Review and Meta-Analysis

“…This retrospective study from Turkey on 186 children with confirmed AA showed no significant difference in the MPV values ( p = 0.536) between AA and non-AA groups [ 23 ]. The study also evaluated the role of other laboratory results like WBC, NLR, RDW, CRP, and procalcitonin levels.…”

“…The average Downs and Black scores for the included studies ranged from 24–28. The studies by Tartar et al and Tuncer et al had the minimum and maximum scores, respectively [ 19 , 23 ]. The inter-observer agreement was almost perfect (Kappa = 0.928, p < 0.0001).…”

“…This validated 27-point scale has four domains of assessment with minimum and maximum scores of 0 and 32, respectively. Based on these scores, the risk of bias was graded as low (score > 23), moderate (16)(17)(18)(19)(20)(21)(22)(23), or high (0-15). The kappa statistics were used to identify the level of inter-rater agreement regarding the risk of bias [11].…”