Significance of laboratory parameters in diagnosing acute appendicitis during pregnancy

Abstract

Background Acute appendicitis (AA) is the most frequently seen surgical emergency in pregnant women and the most frequently encountered cause of non‐obstetric acute abdomen. Due to the physiological and anatomical changes that occur during pregnancy and the limited use of radiological methods, it is difficult to diagnose AA during pregnancy. These conditions increase the risk of morbidity and mortality; therefore, it is crucial to identify ideal laboratory markers that can be utilized to diagnose disease. Methods One hundred and ten pregnancies that fulfilled the inclusion criteria for AA diagnosis were retrospectively analysed between 2010 and 2021. Markers with high diagnostic values were discussed. Results The patients were divided into three groups as follows; Group I: negative appendectomy (n = 19); Group IIa: uncomplicated appendicitis (n = 59); Group IIb: complicated appendicitis (n = 32). There was no statistically significant difference in mean age or gestational week (P > 0.05). Group IIb had a higher rate of complications and a longer length of hospital stay (P < 0.05). There were significant differences between the groups in terms of white blood cell (WBC), neutrophil, neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), C‐reactive protein, lymphocyte‐to‐ C‐reactive protein ratio, total, direct, and indirect bilirubin values (P < 0.05). While platelet and lactate dehydrogenase (LDH) values did not differ substantially between groups, both were found to have a high diagnostic value. Conclusion It was concluded that WBC, neutrophil, NLR, PLR, total, direct and indirect bilirubin levels could be utilized to diagnose AA. Moreover, levels of WBC, neutrophil, NLR, platelet, PLR, LDH, total, direct and indirect bilirubin can be utilized to diagnose complicated appendicitis.

Usefulness of serum sodium levels as a novel marker for predicting acute appendicitis severity: a retrospective cohort study

“…We identified in our study that serum sodium level < 136 mEq/L has a sensitivity of 45.7% and specificity of 86.4% with AUC: 0.696 to diagnose complicated AA ( P < 0.001), results very similar to other markers. Recent studies have also associated the use of artificial intelligence and machine learning to predict severity in AA with high levels of accuracy [ 4 – 6 , 16 , 21 – 23 ].…”

Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis

“…By statistical analysis of preoperative computerised tomography (CT) scans [ 7 ] of acute appendicitis [ 8 ], the volume and distribution of platelets in the blood have been reported. The levels of bilirubin [ 9 ], serum sodium [ 10 ] and 5-hydroxyindoleacetic acid [ 11 ] and the neutrophil to lymphocyte ratio [ 12 , 13 ] have been used to distinguish between simple and complicated appendicitis. However, the specificity was not high, and pathology or intraoperative exploration remains the gold standard for simple or complicated appendicitis diagnosis.…”

A Focus on Intra-Abdominal Sepsis with Biomarkers: A Literature Review

“…It is a marker with high diagnostic efficiency, especially in surgical conditions such as acute appendicitis. 28 , 29 The diagnostic value of WBC in sepsis is limited. However, the criteria in the initial SIRS definition included an increase or decrease in the WBC count (>12 000 or <4000/mm 3 ) or a normal WBC count with >10% bands.…”