Utility of biomarkers in predicting complicated appendicitis: can immature granulocyte percentage and C-reactive protein be used?

ABSTRACT

Background

Acute appendicitis is the most common reason for abdominal surgery in children. The aim of this study was to evaluate the utility of biomarkers in predicting complicated appendicitis (CA).

Methods

Patients having a diagnosis of acute appendicitis who underwent operations were retrospectively determined, and the utility of biomarkers in predicting CA was evaluated.

Results

A total of 251 patients were included in the study. The mean age was 130.9 ± 48.8 months, 148 of the cases (59%) were simple appendicitis, and 103 (41%) were CA. The C-reactive protein (CRP) levels, immature granulocyte (IG) percentage, white blood cell counts, and absolute neutrophil counts were significantly higher in the CA patients. The bilirubin levels and neutrophil to lymphocyte ratios were not useful for predicting CA. The best area under the curve (AUC) values to predict CA were with the IG percentage and CRP level (0.82), the IG percentage [odds ratio (OR) 9.36, 95% CI (4.94–17.75), p < 0.001] and CRP [OR 8.42, 95% CI (4.72–15.02), p < 0.001] were the best marker in predicting CA. The sensitivity of the IG percentage and CRP level were higher than other markers.

Conclusion

To predict CA, the best AUC values were associated with the IG percentage and the CRP level. Because it is easy, fast to measure, does not require taking extra blood, and does not lead to additional costs, IG percentage may be preferred in the diagnosis of patients with CA.

KEYWORDS:

• Acute appendicitis
• immature granulocyte
• biomarkers
• complicated appendicitis

Acknowledgments

The authors gratefully acknowledge Scribendi (www.scribendi.com) for English language editing.

Author contributions

MD Güngör, MD Göktuğ and Prof Tuygun, Karacan and Karaman conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.

Drs Bodur, Öztürk, and Güneylioğlu designed the data collection instruments, collected data, reviewed, and revised the manuscript.

Dr Güngör, Prof Karaman, Yaradılmış carried out the initial analyses, reviewed and revised the manuscript.

All authors approve the final version of manuscript and accept all the responsibilities.

Declaration of funding

None

Declaration of financial/other relationships

The authors have no conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics approval

The protocol for this study was approved by the local ethics committee (E-21/03-136).

Availability of data

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declaration of interest

No potential conflict of interest was reported by the author(s).