Dong Hyuk Shin1, Young Suk Cho2, Yoon Sung Kim3, Hee Cheol Ahn4, Young Taeck Oh4,5, Sang O Park6, Moo-Ho Won7, Jun Hwi Cho5, Young Myeong Kim8, Jeong Yeol Seo9, Young Hwan Lee4,5. 1. Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. 2. Department of Emergency Medicine, School of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, Korea. 3. National Medical center, Seoul, Korea. 4. Department of Emergency Medicine, Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea. 5. Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea. 6. Department of Emergency Medicine, School of Medicine, Konkuk University Konkuk University Medical Center, Seoul, Korea. 7. Department of Neurobiology, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea. 8. Department of Molecular and Cellular Biochemistry, College of Medicine, Kangwon National University, Chunchon, Korea. 9. Department of Emergency Medicine, School of Medcine, Hallym University, Chunchon, Korea.
Abstract
BACKGROUND: Delta neutrophil index (DNI) is a new inflammatory marker and the present study aimed to evaluate the predictive value of the DNI for the presence of a perforation in elderly with acute appendicitis. METHODS: This retrospective observational study was conducted on 108 consecutive elderly patients (≥65 years old) with acute appendicitis treated over a 24-month period. RESULTS: Sixty-nine of the 108 patients (median, IQR: 72, 67-77 years) were allocated to the perforated appendicitis group (63.9%) and 39 to the non-perforated appendicitis group (36.1%). WBC, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and DNI were significantly higher in the perforated group. In multiple logistic regression analyses, initial DNI was the only independent marker that can significantly predict the presence of perforation in multiple regression [odds ratio 9.38, 95% confidence interval (2.51-35.00), P=.001]. Receiver operator characteristic curve analysis showed that DNI is a good predictor for the presence of appendiceal perforation at an optimal cut-off for DNI being 1.4% (sensitivity 67.7%, specificity 90.0%, AUC 0.807). CONCLUSION: Clinicians can reliably differentiate acute perforated appendicitis from non-perforated appendicitis by DNI level of 1.4 or more in elderly patients.
BACKGROUND: Delta neutrophil index (DNI) is a new inflammatory marker and the present study aimed to evaluate the predictive value of the DNI for the presence of a perforation in elderly with acute appendicitis. METHODS: This retrospective observational study was conducted on 108 consecutive elderly patients (≥65 years old) with acute appendicitis treated over a 24-month period. RESULTS: Sixty-nine of the 108 patients (median, IQR: 72, 67-77 years) were allocated to the perforated appendicitis group (63.9%) and 39 to the non-perforated appendicitis group (36.1%). WBC, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and DNI were significantly higher in the perforated group. In multiple logistic regression analyses, initial DNI was the only independent marker that can significantly predict the presence of perforation in multiple regression [odds ratio 9.38, 95% confidence interval (2.51-35.00), P=.001]. Receiver operator characteristic curve analysis showed that DNI is a good predictor for the presence of appendiceal perforation at an optimal cut-off for DNI being 1.4% (sensitivity 67.7%, specificity 90.0%, AUC 0.807). CONCLUSION: Clinicians can reliably differentiate acute perforated appendicitis from non-perforated appendicitis by DNI level of 1.4 or more in elderly patients.
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