ISSN: 2148-4902 | E-ISSN: 2536-4553
Evaluation of the predictive power of laboratory markers in the diagnosis of acute appendicitis in the elderly [North Clin Istanb]
North Clin Istanb. 2019; 6(3): 293-301 | DOI: 10.14744/nci.2019.93457

Evaluation of the predictive power of laboratory markers in the diagnosis of acute appendicitis in the elderly

Savaş Bayrak1, Cihad Tatar1, Ekrem Çakar1, Sukru Colak1, Mehmet Emin Gunes2, Kemal Tekeşin3, Bünyamin Gürbulak1, Erdem Kinaci1, Mert Mahsuni Sevinc1
1Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
2Department of General Surgery, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
3Department of General Surgery, Umraniye Training and Research Hospital, Istanbul, Turkey

INTRODUCTION: The aim of this study was to analyze the predictive value of preoperative laboratory findings in acute appendicitis in geriatric patients aged >65 years.
METHODS: We enrolled a total of 4121 patients. A retrospective evaluation of the demographic features was made using preoperative laboratory values such as the white blood cell (WBC), neutrophil, and lymphocyte counts; platelet counts; the mean platelet volume and bilirubin values; and postoperative pathological data of the patients from the electronic file system. The neutrophil-to-WBC and neutrophil-to-lymphocyte ratios were calculated. Patients were divided into two groups, as geriatric (≥65 years old, n=140) and non-geriatric (<65 years old, n=3981).
RESULTS: The white blood cell and lymphocyte counts, and the neutrophil-to-WBC ratio, were significantly higher in the non-geriatric group (p<0.001, p=0.013, and p=0.021, respectively). The neutrophil and platelet counts were higher in the non-geriatric group, but this difference was not statistically significant (p=0.073 and p=0.072, respectively). A higher neutrophil-to-lymphocyte ratio was determined in the geriatric group, but the difference was not significant (p=0.176). According to the optimumal cutoff value of 12.11×103/µL for WBC, specificity and sensitivity values of 65.4% and 57.9% were calculated, respectively; the AUC value was 0.632±0.024 (p<0.001). A receiver operating characteristic (ROC) analysis was used to calculate the optimum cutoff values of neutrophil-to-WBC ratio, lymphocyte, and the mean platelet volume, but the diagnostic accuracy of these tests was inadequate with an AUC of <0.6.
DISCUSSION AND CONCLUSION: WBC values >12.11×103/µL were predictive of acute appendicitis in geriatric patients. The other parameters were not predictive, and further studies are required.

Keywords: Acute appendicitis, geriatric patients; laboratory parameters.

Savaş Bayrak, Cihad Tatar, Ekrem Çakar, Sukru Colak, Mehmet Emin Gunes, Kemal Tekeşin, Bünyamin Gürbulak, Erdem Kinaci, Mert Mahsuni Sevinc. Evaluation of the predictive power of laboratory markers in the diagnosis of acute appendicitis in the elderly. North Clin Istanb. 2019; 6(3): 293-301

Corresponding Author: Savaş Bayrak

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