Diagnostic accuracy of inflammatory markers in patients operated on for suspected acute appendicitis: a receiver operating characteristic curve analysis
H. Korner et al., Diagnostic accuracy of inflammatory markers in patients operated on for suspected acute appendicitis: a receiver operating characteristic curve analysis, EURO J SURG, 165(7), 1999, pp. 679-685
Objective: To analyse the diagnostic accuracy of inflammatory variables in
patients operated on for suspected acute appendicitis.
Design: Open prospective population based study.
Setting: Teaching hospital, Norway.
Interventions: Appendicectomy in 544 patients with clinically suspected acu
te appendicitis.
Main outcome measures: Diagnostic accuracy of inflammatory variables using
receiver operating characteristic (ROC) curve analysis. Logistic regression
model of inflammatory variables using results of ROC-analysis.
Results: A small area under the ROC curve (AUC) (between 0.56 and 0.69) ind
icated less diagnostic accuracy. The best cut-off values were associated wi
th low sensitivity and specificity, varying from 46% to 88%. Age, duration
of history, and histological grade of inflammation significantly influenced
the test results (AUC > 0.5). The white cell count (WCC) and C-reactive pr
otein (CRP) concentration were independent predictors of acute appendicitis
with cut-off values of >12.3 x 10(9)/L and >0 mg/L, respectively, but AUC
values of over 0.5 were observed only in patients between 13 and 40 years o
f age.
Conclusion: Inflammatory variables added information of limited value in th
e diagnosis of suspected acute appendicitis. The test results should be int
erpreted differently in different groups of patients.