Study Of Platelet Indices In Clinically Diagnosed Acute Appendicitis Using The Alvarado Score

Abstract

INTRODUCTION- Acute appendicitis (AA) is an acute abdominal condition in all age groups, worldwide. If not treated on time this may result in life-threatening complications like perforation of the appendix and that may lead to peritonitis. Early clinical diagnosis and appropriate management on time can reduce the morbidity and mortality rates effectively. In this study, we attempted to find out simple and cost-effective markers which will aid in the clinical diagnosis of acute appendicitis diagnosed by using, the most commonly used the Alvarado scoring system. OBJECTIVE- To determine and compare diagnostic utility of platelet indices (i.e. MPV, PDW, Plateletcrit and P-LCR) in clinically diagnosed cases of acute appendicitis using the Alvarado score with platelet indices of healthy controls. MATERIALS AND METHODS- Patients from both out-patient and in-patient departments, referred to the Department of Pathology in BLDE (Deemed to be University) Shri B.M.Patil Medical College, Hospital and Research centre, Vijayapura were included in the study. All the blood samples of cases, who were clinically diagnosed as acute appendicitis on the bases of the Alvarado scoring system and healthy controls were collected in di-potassium EDTA vacutainers and were processed by Sysmex XN1000 haematology analyser.RESULTS– The study group comprised of 102 cases clinically diagnosed as acute appendicitis using the Alvarado scoring system, out of which 84 cases histopathologically confirmed as acute appendicitis. The mean age of presentation of acute appendicitis was 31±11.5 years. The male to female ratio was 3.1:1. PDW and P-LCR were found to have higher statistically significant values in the cases compared to healthy controls (11.5± 2.2fl vs 10.6±1.3fl and 24.8± 6.6% vs 22.0± 5.2%). On ROC curve analysis mean cut off for PDW and P-LCR were 10.65fl and 22.9% respectively. Sensitivity and specificity of PDW were found to be 60% and 73% respectively and for P-LCR, sensitivity was 58% and specificity was 56%. However, WBC count showed the highest sensitivity and specificity of 77% and 75% respectively, proving it to be specificity wise a more better biomarker. The NLR and PLR were significantly higher (p value <0.001) in acute appendicitis cases. CONCLUSION- In the present study it is emphasized that platelet indices like PDW and P-LCR can be used as supportive aid for the clinical diagnosis of acute appendicitis along with all other clinical components of the Alvarado scoring system, NLR and PLR values.