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The diagnostic accuracy of hematological laboratory parameters in the diagnosis of acute appendicitis in the adult emergency department population

Introduction: The aim of this study was to assess the diagnostic accuracy of some hematological laboratory parameters: platelets (Plt), mean platelet volume (MPV), red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), in the diagnosis of acute appendicitis (AA) in the adult emergency department population. Materials and methods: The study was performed according to the 2015 Standards for Reporting Diagnostic accuracy studies Guidelines. We consecutively included 78 patients admitted to the Emergency Department (ED) with suspected acute appendicitis. Parameters of the complete blood count were measured on Advia 2120i automated hematology analyzer (Siemens, Enlargen, Germany). The difference between two groups was tested with Mann-Whitney test. Logistic regression analysis was performed to identify the significant predictors of AA, among the proposed laboratory parameters. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value of the identified significant predictors. Statistical analyses were performed using MedCalc Statistical Software version 16.2.0 (MedCalc Software bvba, Ostend, Belgium). P<0.05 was defined as the threshold of significance. Results: In total 55/78 patients, in whom AA diagnosis was excluded, were discharged, while 23/78 patients underwent a surgery for AA. In 18/23 patients who underwent the surgery, AA diagnosis was confirmed by histological analysis. There was no statistically significant difference in Plt, MPV and RDW between groups. Although NLR and PLR were significantly higher in the confirmed AA group compared to the discharged patients group (8.5 vs 2.65, and 25.55 vs 10.35, P<0.001, respectively), multivariate analysis identified only NRL as a significant contributor to AA diagnosis (P<0.001). NRL ROC analysis revealed AUC=0.874 (95% CI=0.779 – 0.938) at a cut-off >4.4 (P<0.001) with a sensitivity and specificity of 89% (95% CI=65.3 – 98.6) and 78% (95% CI=65.8 – 87.9), respectively. Conclusion: Plt, MPV, RDW and PLR were not useful parameters for diagnosing acute appendicitis in the adult ED population. NLR above the proposed cut-off >4.4 can be useful aid in the differentiation between the patients with AA and symptomatic individuals with other diagnoses.

STARD guidelines ; acute appendicitis ; hematology

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