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Back to 2015 Annual Meeting Program Acute Appendicitis Without Leucocitosis. Comparison Between Ratios of Neutrophil/Lymphocytes, Leukocytes/Neutrophils and Leukocytes/Bilirubin Raul Gaxiola* GENERAL SURGERY, HOSPITAL GENERAL DE MEXICO, Mexico City, Mexico
Background: Acute appendicitis (AA) is still nowadays one of the most common surgical conditions seen at emergency services. The most imperative goal must be that patients with appendicitis be diagnosed and receive timely surgical intervention, to avoid complications. Leucocytosis is a strong parameter to know if a patient has appendicitis or not; however, there is a large group of patients may have the illness without white blood cells rise. Several papers, scores and laboratory tests have been employed to improve it, but these are not always available, are expensive and cause decision making delays. Objective: The aim of this study was to determine how many patients had appendicitis without white blood cells rise, and if there is another parameter that could improve the diagnosis and the correct decision making. Methods: This is a retrospective cohort study, medical records of 187 patients who underwent appendectomy in 2014 was obtained. Patients were subdivided according to the histopathological classification: Phase 0: No appendicitis, periappendicitis-moderately acute (n = 5); Phase I: acute appendicitis (n = 72); Phase II: acute appendicitis and acute peritonitis (n = 12); Phase III: supurative-acute appendicitis (n = 44); Phase IV: necrohaemorragic perforated-acute appendicitis (n = 35); and others (n = 24). The parameters of the number of leukocytes were diagnosed: the ratios neutrophil/lymphocyte, leukocytes/neutrophils, leukocytes/dhl, and leukocytes/bilirubin, using the receiver operating (ROC) curves and their characteristics. Results: Gender and age showed the following counts: women's average age was 33 yo. (5-80), leukocytosis average 14.49 (4.10 - 32.70); relationship neutrophil/lymphocyte avg of 9.11 (0.82-46.0) and avg 0.89 bilirubin (0 - 3.73). For men the avg age was 31 yo. (5-68), leukocytosis avg of 16.25 (4.0 - 101.1), relationship neutrophil/lymphocyte avg of 13.02 (0.83-78.0) and bilirubin avg 1.57 (0 - 7.01). The behavior of appendicitis associated with leukocytosis correlated according to the histopathological classification, (positive) patients classified without leukocytosis (n=53) and (negative) (n=134) with leukocytosis. For normal values in patients without leukocytosis 6% in phase 0; 47% in Phase I; 9% in Phase II; 17% in Phase III; 8% in Phase IV and the remaining 13% Other. For higher values (<10,000) with leukocytosis was detected that 1% of patients presented in a phase 0; 35% in Phase I; 5% in stage II, 26% in Phase III; 23% in Phase IV and the remaining 9% Other. Back to 2015 Annual Meeting Program |
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