The Use of Delta Neutrophil Index and Myeloperoxidase Index for Predicting Acute Complicated Appendicitis in Children

Abstract

BackgroundIn children with acute appendicitis, 30% to 75% present with a complication, such as perforation, and the early diagnosis of complications is known to improve outcomes. Serum delta neutrophil index (DNI) and myeloperoxidase index (MPXI) are new inflammatory markers, and thus, in the present study, the authors evaluated the predictive values of these two markers for the presence of a complication in children with acute appendicitis.MethodsThis retrospective observational study was conducted on 105 consecutive children (<12 years old) with acute appendicitis treated over a 31-month period. DNI, MPXI, C-reactive protein (CRP), and white blood cells (WBCs) were measured in an emergency department and investigated with respect to their abilities to predict the presence of acute complicated appendicitis.ResultsTwenty-nine of the 105 patients (median age, 9 years) were allocated to the complicated group (27.6%) and 76 to the non-complicated group (72.4%). Median serum DNI and CRP were significantly higher in the complicated group [0% vs. 2.2%, p<0.001 and 0.65 mg/dL vs. 8.0 mg/dL, p<0.001], but median MPXI was not (p = 0.316). Area under curve (AUC) for the ability of serum DNI and CRP to predict the presence of acute complicated appendicitis were 0.738 and 0.840, respectively. Multiple logistic regression analyses showed initial CRP [odds ratio 1.301, 95% confidence interval (1.092–1.549), p = 0.003] significantly predicted the presence of a complication. The optimal cutoff for serum CRP was 4.0 mg/dL (sensitivity 69%, specificity 83%, AUC 0.840).ConclusionsAlthough serum DNI values were significantly higher in children with acute complicated appendicitis, no evidence was obtained to support the notion that serum DNI or serum MPXI aid the differentiation of acute complicated and non-complicated appendicitis in the ED setting.

Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly

“…In previous study by Kim et al 32 , the predictive role of DNI for complicated appendicitis was only fair with AUC of 0.738 in children. In general population, a sensitivity and specificity of the DNI for prediction of perforated appendicitis was reported to be 25.0%…”

“…In children, several studies have indicated that serum CRP is a sensitive (83% to >90%) for detecting appendiceal perforation. 34,35 Kim et al 32 recently reported that serum CRP is a good predictor of complicated appendicitis, with a sensitivity of 69% and a specificity of 83% at a cut-off level of 4.0 mg/dL with an AUC of 0.840 on the ROC curve. In general population, a sensitivity and specificity of CRP for the prediction of perforated appendicitis was 80% and 69%, respectively, at a cut-off level of 9.52 mg/L.…”

Usefulness of the Delta Neutrophil Index as a Promising Prognostic Marker of Acute Cholangitis in Emergency Departments

“…An increase in DNI of >12% at 72 h after ED admission predicted mortality in patients with neonatal sepsis (28). In a recent study, Kim et al (29) investigated the usefulness of DNI as an early predictor of acute complicated appendicitis in children, and observed a significantly higher median DNI in patients with acute complicated appendicitis (2.2%), compared with those with non-complicated appendicitis (0%; P <0.001) (29). Furthermore, a DNI cut-off value of 5.7% was used to determine 30-day mortality at the time of diagnosis of spontaneous bacterial peritonitis (30).…”

Delta neutrophil index as a prognostic marker in emergent abdominal surgery

“…Studies for the role of DNI in differentiating perforated appendicitis from non‐perforated appendicitis have been conducted in the elderly and children . In previous studies, the predictive value of the DNI for complicated appendicitis was good with an AUC of 0.807 in the elderly and fair with an AUC of 0.738 in children.…”