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North Clin Istanb. 2019 Jul 8;6(3):293-301. doi: 10.14744/nci.2019.93457. eCollection 2019.

Evaluation of the predictive power of laboratory markers in the diagnosis of acute appendicitis in the elderly.

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Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
Department of General Surgery, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Department of General Surgery, Umraniye Training and Research Hospital, Istanbul, Turkey.



The aim of this study was to analyze the predictive value of preoperative laboratory findings in acute appendicitis in geriatric patients aged >65 years.


We enrolled a total of 4121 patients. A retrospective evaluation of the demographic features was made using preoperative laboratory values such as the white blood cell (WBC), neutrophil, and lymphocyte counts; platelet counts; the mean platelet volume and bilirubin values; and postoperative pathological data of the patients from the electronic file system. The neutrophil-to-WBC and neutrophil-to-lymphocyte ratios were calculated. Patients were divided into two groups, as geriatric (≥65 years old, n=140) and non-geriatric (<65 years old, n=3981).


The white blood cell and lymphocyte counts, and the neutrophil-to-WBC ratio, were significantly higher in the non-geriatric group (p<0.001, p=0.013, and p=0.021, respectively). The neutrophil and platelet counts were higher in the non-geriatric group, but this difference was not statistically significant (p=0.073 and p=0.072, respectively). A higher neutrophil-to-lymphocyte ratio was determined in the geriatric group, but the difference was not significant (p=0.176). According to the optimumal cutoff value of 12.11×103/µL for WBC, specificity and sensitivity values of 65.4% and 57.9% were calculated, respectively; the AUC value was 0.632±0.024 (p<0.001). A receiver operating characteristic (ROC) analysis was used to calculate the optimum cutoff values of neutrophil-to-WBC ratio, lymphocyte, and the mean platelet volume, but the diagnostic accuracy of these tests was inadequate with an AUC of <0.6.


WBC values >12.11×103/µL were predictive of acute appendicitis in geriatric patients. The other parameters were not predictive, and further studies are required.


Acute appendicitis; geriatric patients; laboratory parameters

Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

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