Diagnostic value of laboratory results in children with acute appendicitis

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Tugay Tartar ◽  
Ünal Bakal ◽  
Mehmet Saraç ◽  
Suleyman Aydin ◽  
Ahmet Kazez
Keyword(s):  
Acute Appendicitis ◽  
Roc Curve ◽  
Operating Characteristic ◽  
Correct Diagnosis ◽  
Perforated Appendicitis ◽  
Diagnostic Value ◽  
Alvarado Score ◽  
P Values ◽  
Reactive Protein ◽  
Diagnosis Rate

AbstractBackgroundThe correct diagnosis rate in acute appendicitis (AA) is between 72 and 94% despite advanced laboratory and radiologic examinations. This study was conducted to determine the effectiveness of laboratory parameters in the diagnosis of children with appendicitis.Materials and methodsPatients who underwent appendectomy were divided as AA (subdivided into two groups as perforated and non-perforated) and without appendicitis. White blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), red cell distribution (RDW), mean platelet volume (MPV), C-reactive protein (CRP), procalcitonin levels and Alvarado score were recorded.ResultsWBC, NLR and CRP levels were higher in patients with AA (p<0.05). According to the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), p values and 95% confidence interval in predicting patients with and without appendicitis were NLR: 0.703, 0.025, 0.523–0.884; CRP: 0.822, <0.001, 0.725–0.919; procalcitonin: 0.631, 0.150, 506–0.755 and Alvarado score: 0.754, 0.05, 0.578–0.930, respectively. RDW, CRP and procalcitonin values of perforated appendicitis patients were higher compared with those of the non-perforated ones (p<0.05). According to the ROC curve, AUC, p values and 95%CI were NLR: 0.583, 0.094, 0.488–0.678; RDW: 0.715, <0.001, 0.628–0.802; CRP: 0.900, <0.001, 0.842–0.958; procalcitonin: 0.865, <0.001, 0.799–0.930 and Alvarado score: 0.727, <0.001, 0.641–0.812, respectively.ConclusionsCRP is the most effective bioindicator in the diagnosis of AA, the detection of perforated cases. It was revealed that NLR is effective in the diagnosis of AA, procalcitonin and RDW values are effective in the separation of perforated cases.

Diagnostic Value of Clinical Prediction Scores for Acute Appendicitis in Children Younger than 4 Years

2021 ◽  
Author(s):  
Ricardo Rassi ◽  
Florencia Muse ◽  
José Sánchez-Martínez ◽  
Eduardo Cuestas
Keyword(s):  
Acute Appendicitis ◽  
Roc Curve ◽  
Operating Characteristic ◽  
Diagnostic Value ◽  
Clinical Prediction ◽  
Alvarado Score ◽  
Predictive Values ◽  
Optimal Criterion ◽  
Area Under Roc Curve ◽  
Appendicitis Score

Abstract Introduction Acute appendicitis can be difficult to diagnose, especially in children < 4 years old. The aim of the present study was to assess the diagnostic value of Alvarado score (AS), appendicitis inflammatory response (AIR) score, and pediatric appendicitis score (PAS) in children younger than 4 years. Materials and Methods All children younger than 4 years who underwent appendicectomy between 2005 and 2019 were included retrospectively. The diagnostic performance of the scores was analyzed using the area under the receiver-operating characteristic (ROC) curve and by calculating the diagnostic performances at optimal criterion value cutoff points. Results In this study, 100 children were included (58 boys and 42 girls) with a median age of 39.5 (12–47) months. Ninety children were diagnosed with pathologically proven acute appendicitis. The area under ROC curve of AS was 0.73, AIR score was 0.79, and PAS was 0.69 (p > 0.05, respectively). In children with low risk of acute appendicitis, negative predictive values were 75.0% for AS, 50.0% for AIR score, and 66.7% for PAS (p < 0.05, respectively). The positive predictive values in children with high risk of acute appendicitis were of 92.7% for AS, 92.6% for AIR score, and 93.6% for PAS (p > 0.05, respectively). AS, AIR score, and PAS plus positive ultrasonography have 0.58, 0.49, and 0.88 area under ROC curve. Conclusion The three scores can be of assistance in the suspicion of acute appendicitis. PAS markedly improved combined with positive ultrasonography, but none can be used in setting the diagnosis of acute appendicitis in young children.

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

2013 ◽  
Vol 95 (3) ◽  
pp. 215-221 ◽  
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.

scholarly journals Diagnosis of Parapneumonia Pleural Effusion With Serum and Pleural Effusion Activin A

2021 ◽  
Author(s):  
Guanghui Zhou ◽  
Yi Shan ◽  
Zhiwei Tang ◽  
Ruhua Chen ◽  
Yan Fen ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Roc Curve ◽  
Operating Characteristic ◽  
Diagnostic Value ◽  
Activin A ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Reactive Protein ◽  
Diagnostic Potential ◽  
Parapneumonic Pleural Effusion

Abstract Background We aimed to evaluate the diagnostic value of Activin A levels in serum and pleural effusion on parapneumonic pleural effusion (PPE). Methods We collected serum and pleural effusion from 86 PPE and 37 non-PPE (NPPE) patients. Including Activin A, levels of biomarkers as lactate dehydrogenase (LDH), procalcitonin (PCT) and C-reactive protein (CRP) were measured. All factors were calculated for association with days after admission. The diagnostic potential of biomarkers on PPE was considered by receiver operating characteristic (ROC) curve analysis. Results Levels of Activin A in serum and pleural effusion of PPE patients were significantly higher than those of the NPPE patients. Moreover, concentrations of Activin A in pleural effusion showed a more obvious relevant days after admission. ROC curve analysis found that Activin A in pleural effusion had AUCs of 0.899 with 93% sensitivity and 84% specificity for PPE diagnosis. Conclusion Activin A in pleural effusion correlated with disease severity could act to diagnosis PPE.

scholarly journals Predictive value of total leucocyte count (TLC), bilirubin and C-reactive protein in the diagnosis of gangrenous and perforated appendicitis.

2019 ◽  
Vol 26 (12) ◽  
pp. 2173-2178
Author(s):  
Muhammad Najam Iqbal ◽  
Shahbaz Ahmad ◽  
Abdullah Saeed ◽  
Muhammad Imran Shah ◽  
Muhammad Zahid Imtiaz Dogar ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Perforated Appendicitis ◽  
Serum Total Bilirubin ◽  
Suspected Case ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Gangrenous Appendicitis ◽  
Perforated Appendix

Acute appendicitis is the most common cause of acute abdomen. Most of the cases are diagnosed on history, clinical examination and raised TLC but gangrenous and perforated appendicitis are difficult to diagnose. The TLC, Serum bilirubin and C‑reactive protein (CRP) have been shown to indicate perforation in appendicitis. Objectives: The purpose of this study was to evaluate the role of TLC, hyperbilirubinemia and CRP in the diagnosis of perforated appendix and surgery should be planned. Study Design: Prospective study. Setting: Department of Surgery in Sheikh Zayed Medical College Rahim Yar Khan. Period: 12 months from November 2017 to October 2018. Material & Methods: This study consisted of patients admitted with the clinical suspicion of acute appendicitis. ALVARADO score was calculated. 120 patients with ALVARADO score more than 6 and histologically diagnosed appendicitis were finally included in the study. A proforma was filled which included patients name, age, sex, duration of pain, TLC count, C-Reactive protein (CRP) level and serum total bilirubin level and diagnosis of appendicitis (acute appendicitis, gangrenous appendicitis and perforated appendicitis. Patients were divided into 3 groups. Group A comprised of patients with features of simple appendicitis (AA), Group B Gangrenous appendicitis (GA) and group C Perforated appendicitis (PA). Results: There were 81 patients of acute appendicitis, 13 patients of gangrenous appendicitis and 26 patients of perforated appendicitis. TLC was raised in 13 patients of AA, 10 patients of gangrenous appendicitis and 24 patients of perforated appendicitis. Hyperbillirubinemia (>1mg/dl) was present in 9 patients of GA and 20 patients of PA. Raised C-Reactive protein level (>5mg) was present in 10 patients of GA and 21 patients of PA. There was significant correlation of raised TLC, hyperbillirubinemia and C-reactive protein in gangrenous and perforated appendicitis and p value was less than 0.05. Predictive value of bilirubin in GA and PA was 56.25 % and 74.04 %respectively. Predictive value of C Reactive Protein in GA and PA was 41.66 and 60 respectively. Predictive value of TLC in GA and PA was 43.47 and 60.86 respectively. Conclusion: All the patients who present with pain in right iliac fossa, lower abdominal tenderness and rigidity, Alvarado score>7, raised TLC, CRP and hybillirubinemia are the suspected case of perforated appendix and should be aggressively resuscitated and operated.

scholarly journals C-reactive protein and total serum bilirubin as a predictor of perforated appendicitis: a cross sectional study

2018 ◽  
Vol 5 (7) ◽  
pp. 2574
Author(s):  
Anil Reddy Pinate ◽  
Shivakumar C. R. ◽  
Mohammad Fazelul Rahman Shoeb ◽  
Sharangouda Patil
Keyword(s):  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Diagnostic Value ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Perforated Appendix

Background: C-reactive protein (CRP) and bilirubin have been used as adjuncts for diagnosis of appendicitis. This study assessed the diagnostic value of these markers in patients with suspected acute appendicitis.Methods: CRP values and total serum bilirubin among the patients who presented with acute appendicitis were compared among patients who had perforated appendix and non- perforated appendix. The diagnostic value of CRP and TSB markers as a predictor for perforation were compared in terms of Sensitivity, specificity, PPVs and NPV and the diagnostic accuracy assessed by AUC using receiver operating characteristic (ROC) curve analysis.Results: This study showed sensitivity is 72.50%, specificity of 92.23%, positive predictive value of 78.38% for a raised CRP. The sensitivity of TSB for predicting perforation is 77.50 and the values of specificity, PPV and NPV of the same are 87.38 %, 70.45% and 90.91% respectively. The area under curve was more for CRP than TSB indicating that CRP is better predictor for perforation in appendicitis as compared to the TSB.Conclusions: Thus, serum CRP and total serum bilirubin (TSB) can be used as useful markers for early diagnosis and prediction of perforation in cases of acute appendicitis.

Diagnostic value of procalcitonin, erythrocyte sedimentation rate (ESR), quantitative C-reactive protein (CRP) and clinical findings associated with osteomyelitis in patients with diabetic foot

2021 ◽  
pp. 1-7
Author(s):  
Zahra Soleimani ◽  
Fatemeh Amighi ◽  
Zarichehr Vakili ◽  
Mansooreh Momen-Heravi ◽  
Seyyed Alireza Moravveji
Keyword(s):  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Roc Curve ◽  
Diabetic Foot ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Diabetic Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation

BACKGROUND: The diagnosis of osteomyelitis is a key step of diabetic foot management. Procalcitonin (PCT) is a novel infection marker. This study aimed to investigate the diagnostic value of procalcitonin and other conventional infection markers and clinical findings in diagnosis of osteomyelitis in diabetic foot patients. METHODS AND MATERIALS: This diagnostic value study was carried out on ninety patients with diabetic infected foot ulcers admitted in Kashan Beheshti Hospital, 2016. After obtaining consent, 10 cc blood sample was taken for measuring serum PCT, CBC, ESR, CRP and FBS. Clinical characteristics of the wounds were noted. Magnetic resonance imaging of the foot was performed in all patients to diagnose osteomyelitis. All statistical analyses were done with the use of SPSS-16. RESULTS: PCT levels were 0.13 ± 0.02 ng/mili patients with osteomyelitis (n= 45) and 0.04 ± 0.02 ng/ml in patients without osteomyelitis (n= 45). PCT, Erythrocyte sedimentation rate and C-reactive protein was found significantly higher in patients with osteomyelitis (p< 0.001). The ROC curve was calculated for PCT. The area under the ROC curve for infection identification was 1 (p< 0.001). The best cut-off value for PCT was 0.085 ng/ml. Sensitivity, specificity, and positive and negative predictive values were 100%, 97.8%,97.8% and 100%, respectively. CONCLUSION: In this group of patients, PCT was useful to discriminate patients with bone infection. Also, Erythrocyte sedimentation rate and C-reactive protein can be used as a marker of osteomyelitis in diabetic patients.

scholarly journals Predictive values of Alvarado score, serum C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis: a prospective study

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Ademola Olusegun Talabi ◽  
Tewogbade Adeoye Adedeji ◽  
Oludayo Adedapo Sowande ◽  
Olusanya Adejuyigbe
Keyword(s):  
Acute Appendicitis ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
C Reactive Protein ◽  
Blood Cell Count ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Wbc Count

Abstract Background The diagnosis of acute appendicitis in children is quite challenging as the rate of negative appendectomy varies between 15 and 57%. Increased utilization of imaging diagnostic facilities in advanced countries seems to have reduced the incidence of operating on normal appendix to a single digit. In low- and middle-income countries, the incidence remains unacceptably high (double digits). Inflammatory markers and scoring systems may be a suitable adjunct to increase diagnostic yield in most third world countries. Thus, the aim of this study was to evaluate the diagnostic value of Alvarado score, white blood cell count, and serum C-reactive protein in children with acute appendicitis. Results The ages of patients ranged between 4 and 15 years with a mean of 11.2 ± 2.8 years. The male to female ratio was 1.4 to 1.0. Nineteen percent of patients had negative appendiceal findings on histological examination. The sensitivity and specificity of Alvarado score, C-reactive protein estimation, total white blood cell count in diagnosing acute appendicitis were 86.4% and 63.2%, 98.8% and 36.8%, and 51.9% and 89.5% respectively. Alvarado score has the highest area under ROC curve analysis 0.824, 95% CI of 0.724 to 0.924 compared with CRP, 0.769. 95% CI of = 0.647 to 0.891 and WBC count, 0.765, 95% CI of 0.643 to 0.887. Both CRP and WBC count showed higher discriminatory values between complicated and uncomplicated appendicitis, p < 0.001. Conclusion Alvarado score outperformed other tests in setting the diagnosis of acute appendicitis. However, none of the tests can be relied on wholly for operative decision. Clinical judgement remains the bedrock for diagnosis and operative management.

sTREM-1 assessment as a diagnostic biomarker for suspected acute appendicitis in children

2019 ◽  
Author(s):  
Tal Taraboulos Klein ◽  
Elkana Kohn ◽  
Baruch Klin ◽  
Tomer Ziv-Baran ◽  
Eran Kozer ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Complete Blood Count ◽  
Surrogate Marker ◽  
Serum Levels ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Reactive Protein ◽  
Significant Difference ◽  
History Of ◽  
Suspected Acute Appendicitis

Abstract Background The typical history of acute appendicitis is observed in less than 60% of cases. Therefore, searching for a surrogate marker is mandatory. Our goal was to determine whether the soluble triggering receptor expressed on myeloid cells (sTREM-1) is an efficient biomarker for acute appendicitis. Methods sTREM-1 serum levels were measured in addition to carrying out routine diagnostic tests (urine dipstick, complete blood count and C- reactive protein) in children admitted to the Emergency Department with suspected appendicitis. Statistical analysis was performed in order to examine whether sTREM-1 was a significant predictor of appendicitis. Results Fifty three of 134 children enrolled in the study were diagnosed with appendicitis. There was no significant difference in serum sTREM-1 levels (p=0.111) between children with or without appendicitis. Leukocytes, neutrophils and CRP were significantly elevated in the appendicitis group (p<0.001). The appendix diameter was significantly larger and the Alvarado score significantly higher in the appendicitis group (p<0.001). Conclusion serum sTREM-1 is not a good marker for acute appendicitis. Customary tests in addition to a proper patient history and physical examination are still the most effective methods to diagnose acute appendicitis.

SOX9 stands for a bio-marker for prostate cancer detection

2020 ◽  
Author(s):  
Hao Zi ◽  
Wen-Lin Tao ◽  
Lei Gao ◽  
Zhao-Hua Yu ◽  
Xiao-Dong Bai ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Roc Curve ◽  
Operating Characteristic ◽  
Diagnostic Value ◽  
Quantitative Real Time Pcr ◽  
Optimal Cutoff ◽  
Qrt Pcr ◽  
Incidence And Mortality ◽  
The Relationship

Abstract Background Prostate cancer is one of common cancers around the world, and in our country the incidence and mortality of PCa are both increasing. More and more reports have revealed that SOX9 is involved in various human cancers. In this study, we aimed to explore the relationship between SOX9 expression and diagnostic value of PCa patients. Methods In this study, quantitative real-time PCR (qRT-PCR) was performed to determine the expression of SOX9 of the 131 PCa patients and 74 healthy volunteers. And receiver operating characteristic (ROC) curve was used to determine the diagnostic value of SOX9 for PCa patients. Results The results of qRT-PCR showed that the expression of serum SOX9 in PCa patients was higher than that in healthy controls (P < 0.05). And the expression of SOX9 was significantly associated with PSA (P = 0.001), differentiation (P = 0.000), and lymph node metastasis (P = 0.000). Besides, the area under the ROC curve (AUC) was 0.966 with the sensitivity of 93.2% and specificity of 87.8% respectively. The optimal cutoff value of SOX9 was 2.34. Conclusions Our results found that SOX9 is a novel oncogene for PCa, and may be a novel and effective biomarker for the diagnosis of patients with PCa.

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