We were read this valuable article “Evaluation of preoperative clinical and serological determinations in complicated acute appendicitis: A score for predicting complicated appendicitis” by García-Amador et al.1 with a great interest. Diagnostic methods based on basic blood parameters and clinical features without the need for advanced imaging methods are very important. This situation is especially important for physicians in rural areas. In this regard, this study will make a significant contribution to the literature. However, we believe that reviewing some points can make a significant contribution to the study.
Firstly, when the recent publications are examined, the negative appendectomy rate varies between 3 and 25%.2,3 This rate increases even more in pregnant patients.4,5 García-Amador et al. (8/292) showed this rate as 2.73%. This rate is far below the current literature. Patients whose appendix histopathology is evaluated as normal appendix, lymphoid hyperplasia, obliterative appendix should be considered as negative appendectomy.3 In the light of these data, patient groups should be re-evaluated in the article.
Secondly, the main emphasis of the study is on basic laboratory parameters. These parameters are affected by various diseases such as hematological diseases, malignant or inflammatory diseases, chronic diseases, allergic diseases, or receiving various drugs.6 It was understood that patients who have these diseases were not excluded from the study. This will lead to erroneous evaluations. The inclusion and exclusion criteria of the study should be well defined.
Thirdly, in many studies, especially the neutrophil-to-lymphocyte ratio (NLR) value was found to be higher than other hemogram parameters in diagnosing acute appendicitis or determining its complication.5,7 Using this parameter can also give better results. On the other hand, although the mean platelet volume (MPV) value is not in the defined model, it has been examined in the article. We do not recommend using MPV value in the diagnosis of acute appendicitis or complicated appendicitis. Because MPV value in complicated appendicitis patients increased in some studies compared to the uncomplicated patient group,8 while in some studies, on the contrary, it was observed that this value decreased in patients with complicated appendicitis.6 This conflict has not yet been clarified. Therefore, it would be more accurate to use the NLR value instead of the MPV value. Again, including the cut-off values of laboratory values in Table 1 will provide important information in the differentiation of complicated and uncomplicated appendicitis.
FundingNo funding.
Conflict of interestThe authors declare no conflict of interest.
