Can mean platelet volume, Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, Platelet-to-Lymphocyte ratios be favourable predictors for the differential diagnosis of appendicitis?

OBJECTIVE: To investigate whether some ratios obtained from complete blood count could be favourable predictors in differentiating appendicitis from mesenteric lymphadenitis, appendicitis and familial Mediterranean fever. METHODS: The retrospective cross-sectional study was conducted at AfyonKocatepe University Medical Faculty, Afyonkarahisar, Turkey, from January 1, 2014, to December 31, 2016, and comprised data of patients who presented to the department of paediatric surgery and paediatrics with symptoms of acute abdomen. Mean platelet volume, neutrophil/lymphocyte ratio, lymphocyte/monocyte ratio, and platelet/lymphocyte ratio of the patients calculated at the time of admission were analysed. SPSS 20 was used for data analysis. RESULTS: Of the 301 patients, there were 139(46.2%) males and 162(53.8%) were females. The overall mean age was 11.5 } 4.33 years. Of the total, 137(45%) had appendicitis, 65(22%) familial Mediterranean fever, and 99(33%) had mesenteric lymphadenitis. Mean platelet volume was significantly different among the study groups (p<0.05). Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were statistically significantly higher (p<0.05) while lymphocyte/monocyte ratio was significantly lower (p<0.05) in appendicitis cases compared to the others. CONCLUSIONS: Mean platelet volume, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were found to be the potent predictors for the differential diagnosis of familial Mediterranean fever and mesenteric lymphadenitis which are mostly confused with appendicitis.

Role of serum cytokines in acute appendicitis and acute mesenteric lymphadenitis among children.

BACKGROUND AND OBJECTIVE: The diagnostic role of serum cytokines depends on the etiology and pathogenesis of acute appendicitis (AA) and acute mesenteric lymphadenitis (AML). The aim of this study was to evaluate differences in cytokine levels between AA and AML. MATERIALS AND METHODS: Data of 7- to 18-year-old children were collected prospectively from October 2010 to October 2013. There were 31 patients with AA (AA group), 26 with AML (AML group), and 17 with elective non-inflammatory surgical disease (control group). Serum levels of IL-10, IL-12(p70), IL-1ß, IL-4, IL-6, IL-8, IL-17, MCP-1, EGF, TNF-α and white blood count (WBC) were measured three times consecutively in each group. RESULTS: The level of IL-6 and IL-10 was significantly higher in the AA group than the AML group at the first measurement (8pg/mL vs. 3.2pg/mL, P=0.000; 6.1pg/mL vs. 3.2pg/mL, P=0.005, respectively). There was a significant difference observed in time dynamics of concentration of IL-6 and MCP-1 for AA and AML. The area under the curve (AUC) was 0.77 (95% CI 0.64-0.89; P=0.001) for IL-6 with a cut-off value of 4.3pg/mL (67.7% sensitivity and 76.9% specificity) for AA 1h before surgery. The AUC for WBC was 0.72 (95% CI 0.58.4-0.85; P=0.005) with a cut-off value of 10.7×103/µL (sensitivity 71.0% and specificity 46.2%). CONCLUSIONS: Serum IL-6 with a cut-off value of 4.3pg/mL and WBC with a cut-off value of 10.7×103/µL assessed together will yield more sensitivity for AA.

Serum alpha interferon in children with right iliac fossa pain.

Serum alpha-interferon levels were analysed in 50 consecutive children admitted with right iliac fossa pain. Serum alpha-interferon levels were significantly raised in 33% of children without acute appendicitis when compared to 5.7% of children with histologically proven acute appendicitis and 9% of normal controls. This interesting phenomenon needs further investigation. A larger series may show it to be of clinical use in non-specific abdominal pain in childhood.