Abstract
Background
Acute appendicitis ranges from mild inflammation to perforation. A clinically important subset of cases harbors an occult appendiceal neoplasm that is often indistinguishable from routine appendicitis preoperatively. Blood-derived inflammatory indices have been proposed as predictors of disease severity and malignancy. We evaluated the diagnostic value of platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and CRP/SII for predicting complicated appendicitis and identifying neoplasms.
Methods
We conducted a 5-year retrospective study of 837 appendectomies at a tertiary surgical center. Preoperative clinical, laboratory, imaging, and histopathologic findings were analyzed. Appendicitis severity was classified according to WSES criteria. Diagnostic performance was assessed using logistic regression and receiver-operating characteristic (ROC) analysis.
Results
Appendiceal neoplasms were found in 1.1% of patients and were uniformly unsuspected intraoperatively. Neoplastic patients were significantly older (P < 0.001) and had higher PLR and SII (P < 0.001 and P = 0.005). PLR (AUC 0.868) and SII (AUC 0.770) showed the strongest discrimination between benign and malignant pathology. CRP/SII showed the best performance for complicated appendicitis (AUC 0.703). Age, PLR, and CRP/SII were independent predictors of neoplasm, while SII, PLR, and CRP/SII were independently associated with complicated disease.
Discussion
Appendiceal neoplasms may present as clinically uncomplicated appendicitis. Simple inflammatory indices—particularly PLR and SII—were associated with both disease severity and hidden malignancy. These inexpensive and widely available markers may support early surgical decision-making in older or high-risk patients. Prospective validation is needed to define optimal thresholds and refine their role in preoperative triage.
Keywords
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