Sangar ABDULLAH, Kazım DUMAN, Güney ÖZKAYA, Adnan GÜNDOĞDU
Anatolian Current Medical Journal - 2026;8(4):759-765
Aims: Distinguishing complicated from uncomplicated acute appendicitis before surgery has important implications for surgical planning and patient counseling. This study aims to evaluate and compare the diagnostic value of inflammatory biomarkers and liver function tests in differentiating complicated from uncomplicated acute appendicitis, and to determine whether their combined use improves predictive performance over inflammatory markers alone. Methods: A total of 722 appendectomy patients from a single institution were retrospectively analyzed. Based on operative findings and histopathological reports, patients were classified as complicated (gangrenous, perforated, abscess) or uncomplicated. Preoperative white blood cell count (WBC), neutrophil, lymphocyte, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were analyzed. Diagnostic performance was evaluated using ROC analysis, logistic regression, and DeLong test model comparison. Results: Of 722 patients, 637 (88.2%) had uncomplicated and 85 (11.8%) had complicated appendicitis. CRP (p<0.001), NLR (p=0.004), and direct bilirubin (p=0.009) differed significantly between groups. Among individual parameters, CRP showed the highest AUC (0.638) and was the only independent predictor in multivariate analysis (OR: 1.007; p<0.001). The inflammatory markers model (AUC: 0.684) significantly outperformed the liver function tests model (AUC: 0.553; p=0.001). Adding liver function tests to inflammatory markers did not improve prediction (p=0.959). Conclusion: CRP was the strongest and most robust independent predictor of complicated appendicitis. Liver function tests did not improve prediction when added to inflammatory markers. Its modest discriminatory ability suggests CRP should support rather than replace clinical evaluation.
