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Traces of Inflammation in Acute Appendicitis, Cholecystitis, and Diverticulitis: The Role of Biomarkers in Diagnosis
Serap Ulusoy, Furkan SavaşGeneral Surgery, Ankara Bilkent City Hospital, Ankara, TürkiyeINTRODUCTION: Acute appendicitis, acute cholecystitis, and acute diverticulitis are among the most common causes of acute abdominal pain, requiring early diagnosis and rapid treatment. Although imaging modalities such as ultrasonography and computed tomography play a crucial role in diagnosis, access to these methods may be limited in certain situations. Inflammatory biomarkers, including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and delta neutrophil index (DNI), have been suggested as potential tools for differential diagnosis. This study aims to evaluate the diagnostic value of these biomarkers.
METHODS: This retrospective study included 171 patients diagnosed with acute appendicitis (n=62), acute diverticulitis (n=56), and acute cholecystitis (n=53). White blood cell (WBC), neutrophil, lymphocyte, and eosinophil counts, as well as NLR, DNI, and CRP levels, were compared. Statistical analyses and ROC analysis were performed to assess the diagnostic performance of these biomarkers.
RESULTS: CRP and lymphocyte levels were found to be significantly higher in the acute diverticulitis group (p < 0.05). Although DNI, NLR, WBC, and neutrophil levels were elevated in all three groups, no statistically significant difference was observed between them (p > 0.05). ROC analysis demonstrated that DNI has a moderate diagnostic potential for all three diseases, but none of the biomarkers provided high specificity.
DISCUSSION AND CONCLUSION: Inflammatory biomarkers alone are not sufficient as a diagnostic tool for differentiating acute appendicitis, acute cholecystitis, and acute diverticulitis. However, CRP may be useful in assessing disease severity in patients with diverticulitis. Particularly in settings where access to imaging modalities is limited or unavailable, biomarkers such as CRP, DNI, and NLR may serve as supportive tools for diagnosis. Nevertheless, large-scale, multicenter studies are required to better define the role of inflammatory response and biomarkers in differential diagnosis and prognosis.
Manuscript Language: English