Novel serum inflammatory markers in acute appendicitis

AbstractSerum inflammatory markers are used in the prognostication of colorectal cancer (CRC); however, the corresponding role of positron emission tomography (PET)-derived inflammatory markers remains unclear. This study aimed to investigate the prognostic value of 18F-fluorodeoxyglucose (FDG) uptake in the bone marrow and spleen of patients with CRC and evaluate the relationship between FDG uptake estimates in these organs and serum inflammatory markers. In total, 411 patients who underwent preoperative FDG PET/computed tomography (CT) within 1 month of surgery were enrolled. The mean standardized uptake values of the bone marrow and spleen were normalized to the value of the liver, thereby generating bone marrow-to-liver uptake ratio (BLR) and spleen-to-liver uptake ratio (SLR) estimates. The value of BLR and SLR in predicting overall survival (OS) was assessed using the Cox proportional hazards model. The correlation between BLR or SLR and neutrophil-to-lymphocyte ratio (NLR) was evaluated. The predictive accuracy of BLR alone and in combination with SLR was compared using the integrated area under the receiver operating characteristic curves (iAUC). In the univariate analysis, BLR (> 1.06) and SLR (> 0.93) were significant predictors of OS. In the multivariate analysis, BLR was an independent predictor of OS (hazard ratio = 5.279; p < 0.001). Both BLR and SLR were correlated with NLR (p < 0.001). A combination of BLR and SLR was better than BLR alone at CRC prognostication (iAUC, 0.561 vs. 0.542). FDG uptake estimates in the bone marrow and spleen may be useful imaging-derived biomarkers of systemic inflammation, supporting CRC prognostication.

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Reader response: Acute elevation of serum inflammatory markers predicts symptom recovery after concussion

Neurology ◽

10.1212/wnl.0000000000009662 ◽

2020 ◽

Vol 94 (24) ◽

pp. 1111.2-1112

Author(s):

Nitin K. Sethi

Keyword(s):

Reader Response ◽

Inflammatory Markers ◽

Acute Elevation ◽

Symptom Recovery ◽

Serum Inflammatory Markers

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Contribution of Serum Inflammatory Markers to Changes in Bone Mineral Content and Density in Postmenopausal Women: A 1-Year Investigation

Journal of Clinical Densitometry ◽

10.1016/j.jocd.2010.04.003 ◽

2010 ◽

Vol 13 (3) ◽

pp. 277-282 ◽

Cited By ~ 28

Author(s):

E.R. Gertz ◽

N.E. Silverman ◽

K.S. Wise ◽

K.B. Hanson ◽

D.L. Alekel ◽

...

Keyword(s):

Bone Mineral Content ◽

Postmenopausal Women ◽

Bone Mineral ◽

Inflammatory Markers ◽

Mineral Content ◽

Serum Inflammatory Markers

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EP.FRI.479 Clinical accuracy of u/sound combined with inflammatory markers in Acute Appendicitis

British Journal of Surgery ◽

10.1093/bjs/znab312.080 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Nadia Gulnaz ◽

Sadia Tasleem ◽

Farooq Abdullah

Keyword(s):

Acute Appendicitis ◽

Clinical Diagnosis ◽

Inflammatory Markers ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Negative Appendectomy ◽

Care Hospital ◽

Clinical Accuracy ◽

Negative Appendicectomy ◽

Sensitivity Specificity

Abstract Traditionally acute appendicitis has been a clinical diagnosis based on patients' history and physical examination, but the accuracy of clinical diagnosis ranges from 70-95%. Pre-operative diagnosis of acute appendicitis still remains an enigmatic challenge, because no single test alone can reduce the rate of negative appendectomy. Hence some authors have recommended a combination of two or more investigations to increase accuracy and therefore the use of imaging is gaining support. The objective of the study was to determine the clinical accuracy of ultrasound, combined with inflammatory markers such as CRP, WBC, and neutrophilia keeping histopathology as the gold standard. Methods The study was conducted in a Tertiary care hospital in Peshawar from September 2014 to March 2015 on 250 patients who were clinically diagnosed with acute appendicitis. All these patients underwent u/sound scanning in addition to blood tests. Findings In this study, WBC had the highest sensitivity (77.68%) followed by neutrophil% (69.96%), CRP(67.10%), and U/Sound (62.96%) respectively. While U/Sound had the highest specificity (70.59%) followed by CRP and TLC (64.71% each) and neutrophil% (58.82%) respectively. When all the four tests were combined the sensitivity, specificity, (99.17% and 98.45%) increased significantly. When all four tests were negative, appendicitis could be safely ruled out. Conclusion Acute appendicitis is very unlikely and surgery can be safely deferred in these patients when all tests are negative thereby reducing the negative appendicectomy rates.

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Diagnostic accuracy of serum inflammatory markers in late fracture-related infection

The Bone & Joint Journal ◽

10.1302/0301-620x.100b12.bjj-2018-0586.r1 ◽

2018 ◽

Vol 100-B (12) ◽

pp. 1542-1550 ◽

Cited By ~ 13

Author(s):

J. van den Kieboom ◽

P. Bosch ◽

J. D. J. Plate ◽

F. F. A. IJpma ◽

R. Kuehl ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Inflammatory Markers ◽

Meta Analysis ◽

Diagnostic Value ◽

Mixed Effects Models ◽

C Reactive Protein ◽

Reactive Protein ◽

Erythrocyte Sedimentation ◽

Serum Inflammatory Markers

Aims To assess the diagnostic value of C-reactive protein (CRP), leucocyte count (LC), and erythrocyte sedimentation rate (ESR) in late fracture-related infection (FRI). Materials and Methods PubMed, Embase, and Cochrane databases were searched focusing on the diagnostic value of CRP, LC, and ESR in late FRI. Sensitivity and specificity combinations were extracted for each marker. Average estimates were obtained using bivariate mixed effects models. Results A total of 8284 articles were identified but only six were suitable for inclusion. Sensitivity of CRP ranged from 60.0% to 100.0% and specificity from 34.3% to 85.7% in all publications considered. Five articles were pooled for meta-analysis, showing a sensitivity and specificity of 77.0% and 67.9%, respectively. For LC, this was 22.9% to 72.6%, and 73.5% to 85.7%, respectively, in five articles. Four articles were pooled for meta-analysis, resulting in a 51.7% sensitivity and 67.1% specificity. For ESR, sensitivity and specificity ranged from 37.1% to 100.0% and 59.0% to 85.0%, respectively, in five articles. Three articles were pooled in meta-analysis, showing a 45.1% sensitivity and 79.3% specificity. Four articles analyzed the value of combined inflammatory markers, reporting an increased diagnostic accuracy. These results could not be pooled due to heterogeneity. Conclusion The serum inflammatory markers CRP, LC, and ESR are insufficiently accurate to diagnose late FRI, but they may be used as a suggestive sign in its diagnosis.

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The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609957371 ◽

2013 ◽

Vol 95 (3) ◽

pp. 215-221 ◽

Cited By ~ 28

Author(s):

I G Panagiotopoulou ◽

D Parashar ◽

R Lin ◽

S Antonowicz ◽

AD Wells ◽

...

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Cell Count ◽

Inflammatory Markers ◽

White Cell Count ◽

Perforated Appendicitis ◽

Diagnostic Value ◽

White Cell ◽

C Reactive Protein ◽

Reactive Protein

Introduction Inflammatory markers such as white cell count (WCC) and C-reactive protein (CRP) and, more recently, bilirubin have been used as adjuncts in the diagnosis of appendicitis. The aim of this study was to determine the diagnostic accuracy of the above markers in acute and perforated appendicitis as well as their value in excluding the condition. Methods A retrospective analysis of 1,169 appendicectomies was performed. Patients were grouped according to histological examination of appendicectomy specimens (normal appendix = NA, acute appendicitis = AA, perforated appendicitis = PA) and preoperative laboratory test results were correlated. Receiver operating characteristic (ROC) curve area analysis (area under the curve [AUC]) was performed to examine diagnostic accuracy. Results ROC analysis of all laboratory variables showed that no independent variable was diagnostic for AA. Good diagnostic accuracy was seen for AA when all variables were combined (WCC/CRP/bilirubin combined AUC: 0.8173). In PA, the median CRP level was significantly higher than that of AA (158mg/l vs 30mg, p<0.0001). CRP also showed the highest sensitivity (100%) and negative predictive value (100%) for PA. CRP had the highest diagnostic accuracy in PA (AUC: 0.9322) and this was increased when it was combined with WCC (AUC: 0.9388). Bilirubin added no diagnostic value in PA. Normal levels of WCC, CRP and bilirubin could not rule out appendicitis. Conclusions CRP provides the highest diagnostic accuracy for PA. Bilirubin did not provide any discriminatory value for AA and its complications. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis.

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