Comparative evaluation of inflammatory biomarkers and total bilirubin for the early detection of complicated appendicitis in adults

Abstract

Introduction/Objective Acute appendicitis (AA) is the most frequent cause of emergency surgical interventions, and numerous biomarkers can be used diagnostically to differentiate patients with AA from those with pain of other etiologies, as well as to predict disease progression. The aim of this paper is to determine the accuracy of neutrophil-lymphocyte ratio (NLR), procalcitonin (PCT) and total bilirubin (TBil) in the diagnosis of complicated АА (CоАА) and their comparison with the Alvarado score (AS) as well as the histopathological (HP) findings.

Methods AA was diagnosed preoperatively in 67 patients using AS. Examined parameters and AS were determined before surgery and compared postoperatively with HP findings. Depending on the HP findings, the respondents were classified into three groups: gangrenous and gangrenous-perforated appendicitis, which are classified into CoAA, phlegmonous (PhAA) and catarrhal AA (CAA).

Results The results of the univariate analysis show that а one-unit increase in NLR increased the probability of CoAA by 20% (1.02 to 1.51, p < 0.05). PCT ≥ 0.5 ng/ml increases the probability of CoAA by 26.84 times (3.30 to 218.55; p < 0.001), while TBil > 21µmol/l increases the probability of CoAA by 4.80 times (1.41 to 16.37, p < 0.05). ROC curve showed that PCT was the best predictor of CoAA compared to CAA/ PhAA, with a cut-off of 0.56, as well as CAA in relation to PhAA/CoAA with a cut-off of 0.37.

Conclusion PCT, TBil, and NLR can be used in daily clinical practice as powerful, easily available, inexpensive parameters in the diagnosis of CoAA in adults.

Keywords: inflammatory biomarkers; total bilirubin; complicated acute appendicitis