Mekrugsakit Natchanok, Tullavardhana Thawatchai
Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Ongkharak Nakhon-nayok, Thailand.
Arch Acad Emerg Med. 2023 Jun 3;11(1):e42. doi: 10.22037/aaem.v11i1.2020. eCollection 2023.
Low accuracy of clinical variables can result in delayed diagnosis and increase the incidence of complicated appendicitis in some cases. This study aimed to determine the value of simple complete blood count (CBC) biomarkers in predicting complicated appendicitis.
This is a single-center retrospective cross-sectional study, which was conducted on cases referred to emergency department following acute appendicitis who underwent appendectomy, to evaluate the accuracy of some cell blood count variables (white blood cell count (WBC), neutrophil percent, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV)) in predicting complicated cases (gangrenous and ruptured appendicitis).
There were 252 (68.3%) patients in the uncomplicated appendicitis group and 117 (31.7%) patients in the complicated appendicitis group. The mean age of patients was 34.1 ± 1.09 (Range: 18 -79) years (55.3% male). There were no differences between groups regarding the mean age (p = 0.053), gender distribution (p=0.07), Alvarado score (p = 0.055), platelet count (p =0.204), PLR (p = 0.115), and MPV (p = 0.205). The complicated appendicitis cases had longer onset of symptoms (p <0.001), higher WBC count (p = 0.011), higher neutrophil count (p < 0.001), and higher NLR (p < 0.001). Neutrophil count (area under the curve (AUC) = 0.61, 95% confidence interval (CI) = 0.56-0.66; p = 0.001) and NLR (AUC = 0.65, 95% CI = 0.60-0.69; p = 0.001) had higher level of accuracy in this regard. In contrast, the area under the curve of WBC count (AUC = 0.57, 95% CI = 0.52-0.63; p = 0.22), platelet count (AUC = 0.44, 95% CI = 0.38-0.49; p = 0.049), PLR (AUC = 0.57, 95% CI = 0.52-0.62; p = 0.026), and MPV (AUC = 0.54, 95% CI = 0.49-0.60; p = 0.193) showed low accuracy in predicting complicated acute appendicitis.
Based on the findings of present study it seems that WBC, neutrophil percent, NLR, PLR, and MPV have failed to poor accuracy in predicting cases with complicated appendicitis in emergency department.
临床变量的低准确性可能导致诊断延迟，并在某些情况下增加复杂性阑尾炎的发生率。本研究旨在确定简单的全血细胞计数（CBC）生物标志物在预测复杂性阑尾炎中的价值。
这是一项单中心回顾性横断面研究，对因急性阑尾炎转诊至急诊科并接受阑尾切除术的病例进行研究，以评估一些血细胞计数变量（白细胞计数（WBC）、中性粒细胞百分比、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、平均血小板体积（MPV））在预测复杂性病例（坏疽性和穿孔性阑尾炎）中的准确性。
非复杂性阑尾炎组有252例（68.3%）患者，复杂性阑尾炎组有117例（31.7%）患者。患者的平均年龄为34.1±1.09岁（范围：18 - 79岁）（男性占55.3%）。两组在平均年龄（p = 0.053）、性别分布（p = 0.07）、阿尔瓦拉多评分（p = 0.055）、血小板计数（p = 0.204）、PLR（p = 0.115）和MPV（p = 0.205）方面无差异。复杂性阑尾炎病例的症状发作时间更长（p < 0.001）、白细胞计数更高（p = 0.011）、中性粒细胞计数更高（p < 0.001）和NLR更高（p < 0.001）。中性粒细胞计数（曲线下面积（AUC）= 0.61，95%置信区间（CI）= 0.56 - 0.66；p = 0.001）和NLR（AUC = 0.65，95% CI = 0.60 - 0.69；p = 0.001）在这方面具有较高的准确性。相比之下，白细胞计数（AUC = 0.57，95% CI = 0.52 - 0.63；p = 0.22）、血小板计数（AUC = 0.44，95% CI = 0.38 - 0.49；p = 0.049）、PLR（AUC = 0.57，95% CI = 0.52 - 0.62；p = 0.026）和MPV（AUC = 0.54，95% CI = 0.49 - 0.60；p = 0.193）在预测复杂性急性阑尾炎方面准确性较低。
根据本研究结果，白细胞、中性粒细胞百分比（NLR）、血小板与淋巴细胞比值（PLR）和平均血小板体积（MPV）在急诊科预测复杂性阑尾炎病例时准确性欠佳。
