Evaluation of predictive power of laboratory markers in diagnosis of acute appendicitis in elderly

Abstract

OBJECTIVE:The aim of this study was to analyze the predictive value of preoperative laboratory findings in acute appendicitis in geriatric patients aged >65 years.METHODS:We enrolled a total of 4121 patients. A retrospective evaluation of the demographic features was made using preoperative laboratory values such as the white blood cell (WBC), neutrophil, and lymphocyte counts; platelet counts; the mean platelet volume and bilirubin values; and postoperative pathological data of the patients from the electronic file system. The neutrophil-to-WBC and neutrophil-to-lymphocyte ratios were calculated. Patients were divided into two groups, as geriatric (≥65 years old, n=140) and non-geriatric (<65 years old, n=3981).RESULTS:The white blood cell and lymphocyte counts, and the neutrophil-to-WBC ratio, were significantly higher in the non-geriatric group (p<0.001, p=0.013, and p=0.021, respectively). The neutrophil and platelet counts were higher in the non-geriatric group, but this difference was not statistically significant (p=0.073 and p=0.072, respectively). A higher neutrophil-to-lymphocyte ratio was determined in the geriatric group, but the difference was not significant (p=0.176). According to the optimumal cutoff value of 12.11×103/µL for WBC, specificity and sensitivity values of 65.4% and 57.9% were calculated, respectively; the AUC value was 0.632±0.024 (p<0.001). A receiver operating characteristic (ROC) analysis was used to calculate the optimum cutoff values of neutrophil-to-WBC ratio, lymphocyte, and the mean platelet volume, but the diagnostic accuracy of these tests was inadequate with an AUC of <0.6.CONCLUSION:WBC values >12.11×103/µL were predictive of acute appendicitis in geriatric patients. The other parameters were not predictive, and further studies are required.

Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem

“…Elevated white blood cell (WBC) count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and delta neutrophil index (DNI) are possible markers of perforated appendicitis in the elderly, with DNI being the only one that can significantly predict perforation, with a cut-off value of 1.4% (sensitivity 67.7%, specificity 90.0%) [ 10 ]. While comparing geriatric versus non-geriatric patients, WBC, lymphocyte count and neutrophil/WBC ratio were statistically higher in the non-geriatric group, with only WBC being statistically significant [ 20 ].…”

Diagnostic Value of Laboratory Parameters for Complicated Appendicitis: A Two-center Study

“…Furthermore, CRP is a serum in ammatory marker and a critical factor associated with complicated appendicitis [2,14,17,26]. It increases rapidly to several-fold of the normal value in the early stage of in ammation (6-12 h) [27].…”

Clinical-pathological features and treatment of acute appendicitis in the very elderly: an interim analysis of the FRAILESEL Italian multicentre prospective study

“…Regarding laboratories value, only few studies have investigated the predictive role of preoperative laboratory parameters. (30,31). According to the literature, the age of the patient is one of the most important factor affecting the degree of elevation in in ammatory markers.…”