Worldwide, appendicectomy is still most commonly performed in cases of acute appendicitis, which is a common cause of severe abdominal pain that necessitates immediate surgical intervention [1]. Although it can strike anyone at any time, teenagers and young adults are the demographics most often impacted. Acute appendicitis is a well-known clinical entity, but it can be difficult to diagnose, especially in its early stages or in patients with unusual symptoms. Negligible or postponed diagnosis can lead to consequences such perforation, peritonitis, abscess development, and higher rates of illness and death [2-4].

Clinical examination, backed by laboratory investigations and imaging techniques, has traditionally been used to diagnose acute appendicitis. A clinical diagnosis is based on classic symptoms such pain in the right lower quadrant, anorexia, nausea, vomiting, and fever, as well as evidence of localized peritonitis. There is a high percentage of negative appendicectomy because these symptoms are not always present in patients and because there is a lot of overlap with other causes of acute abdomen [5].

Ultrasound and computed tomography are two imaging modalities that have greatly enhanced diagnostic accuracy; yet, their accessibility, affordability, radiation exposure, and reliance on operators may restrict their routine use. Therefore, there is a rising need for easy-to-measure, quick-to-implement, and cost-effective laboratory parameters that can aid in the precise and timely diagnosis of acute appendicitis [6].

The systemic inflammatory response linked to inflammation in the appendix is reflected in hematological and inflammatory markers such as C-reactive protein, platelet indices, total and differential white blood cell counts, neutrophil-lymphocyte ratios, and differential white blood cell counts. The use of these markers in predicting the severity of appendicitis and its consequences, as well as in differentiating it from other sources of abdominal pain, has been proposed in multiple studies. The diagnostic accuracy of these indicators, however, varies substantially between clinical contexts and patient populations [7, 8]. This study set out to address this gap in knowledge by investigating the clinical relevance of certain inflammatory and haematological markers in the diagnosis of acute appendicitis in patients who presented with suspected appendicitis. The secondary objective was to determine whether these markers could be useful adjuncts to routine clinical evaluation in enhancing diagnostic accuracy and decreasing rates of negative appendicectomy [9, 10].

This prospective observational study was carried out in the Department of General Surgery, MGM Hospital, Warangal during the period from May 2024 to April 2025. 50 consecutive patients with a clinical suspicion of acute appendicitis were enrolled following the acquisition of informed consent. All patients had comprehensive clinical assessment, encompassing history taking and physical examination. All patients had appendectomy, and the definitive diagnosis was corroborated by histological analysis of the excised appendix, regarded as the gold standard.

Inclusion Criteria:

• Patients aged ≥18 years.
• Patients presenting with clinical features suggestive of acute appendicitis, including right lower quadrant abdominal pain, tenderness, nausea, vomiting.
• Patients who underwent appendicectomy with availability of histopathological confirmation.
• Patients who provided written informed consent to participate in the study.

Exclusion Criteria:

• Patients below 18 years of age.
• Patients with appendicular mass or abscess managed conservatively.
• Patients with known hematological disorders, chronic inflammatory diseases.
• Patients with current infections other than appendicitis that could alter inflammatory markers.
• Patients on immunosuppressive therapy, corticosteroids, or chemotherapy.
• Pregnant women.
• Patients who refused consent or had incomplete laboratory data.

Statistical Analysis:

The data was imported into Excel and then analyzed using SPSS version, which is a statistical package for the social sciences. Mean ± standard deviation was used to represent continuous variables, whilst frequencies and percentages were used to portray categorical variables. In order to evaluate the diagnostic accuracy of the markers and find the best cut-off values for them, we used receiver operating characteristic (ROC) curve analysis. Statistical significance was determined by a p-value less than 0.05.

The study comprised 50 patients who were clinically suspected of having acute appendicitis. The following five tables show the results in a short form.

Table 1: Demographic Profile of the Study Population

The bulk of the patients were young adults, with an average age of 27.8 ± 9.6 years. With 64% of the sample being male and a ratio of about 1.8:1, the study was skewed toward men.

Table 2: Clinical Presentation of Patients with Suspected Acute Appendicitis

Abdominal pain in the right lower quadrant was the presenting symptom for all individuals. In 76% of cases, patients reported nausea or vomiting; in 60% of cases, rebound discomfort was noted; and in 68% of cases, anorexia was noted. A significant number of patients (44% to be exact) experienced fever, suggesting a systemic inflammatory response.

Table 3: Histopathological Findings after Appendicectomy

In 48 individuals (96%) the diagnosis of appendicitis was confirmed by histopathological testing. The majority of cases (72%), along with suppurative appendicitis (16%) and gangrenous or perforated appendicitis (8%), were acute, uncomplicated appendicitis. A low negative appendicectomy rate was shown by the 4% of cases in which a normal appendix was found.

Table 4: Hematological and Inflammatory Marker Profile at Admission

In 76% of patients, there was an increased total leukocyte count; in 72% of instances, there was neutrophilia; and in 80% of cases, there was higher NLR. Thrombocytosis was observed in 24% of patients, and C-reactive protein was raised in 68%. The frequency of elevation was highest for NLR when compared to all metrics.

Table 5: Diagnostic Performance of Hematological and Inflammatory Markers

Among the measures that were analyzed, NLR had the best sensitivity (88.6%) and specificity (83.3%). It was used to diagnose acute appendicitis. When it came to detecting actual positive cases, CRP also shown strong specificity (83.3%). The specificity was reduced compared to the sensitivity of total leukocyte count and neutrophil percentage. The most accurate diagnosis was achieved when NLR and CRP were used together.

Acute appendicitis exhibited a higher prevalence among young individuals (mean age: 27.8 years) and was predominantly observed in men within this group. In accordance with previous studies, appendicitis is more prevalent in males than in women, typically occurring in middle age and beyond. This demographic trend reflects the epidemiological distribution of the disease [11, 12].

The predominant symptom reported by all patients in this study was pain in the right lower quadrant of the abdomen. Additional prevalent symptoms encompassed anorexia, fever, emesis, and rebound tenderness. In accordance with prior studies, abdominal pain is the most dependable clinical sign of acute appendicitis; additional useful markers encompass gastrointestinal symptoms and localized tenderness [13, 14].

There was a low rate of negative appendicectomy at 4% in this study, and histological investigation proved appendicitis in 96% of cases. In accordance with prior studies, histopathology remains the primary technique for definitively diagnosing illnesses and assessing their severity. The low normal appendix rate in this series indicates high diagnostic accuracy in both clinical and laboratory environments [15-17].

This study accurately diagnosed acute appendicitis through elevated total leukocyte count and neutrophilia. Leukocytosis and neutrophil predominance, as established in prior studies, were identified as reliable indicators of acute inflammation and infection; however, their specificity was diminished due to their elevation in other inflammatory conditions [18].

The neutrophil-lymphocyte ratio had the highest sensitivity and specificity among all investigated markers, establishing it as the most significant hematological parameter in this study. In accordance with previous studies, NLR has demonstrated efficacy as a user-friendly, cost-effective biomarker that surpasses conventional leukocyte indices in diagnostic assessments. A potential rationale for its enhanced diagnostic precision in acute inflammation is its ability to indicate both neutrophil activity and lymphocyte suppression [19, 20].

Patients with appendicitis in this study exhibited significantly elevated C-reactive protein levels, which showed remarkable specificity, particularly in cases of complicated disease. Perforated or gangrenous appendicitis can be diagnosed using CRP, which correlates with the intensity and duration of inflammation, as demonstrated in previous studies. The integration of CRP assessment with leukocyte markers enhanced overall diagnostic confidence [21, 22].

Thrombocytosis was identified in a limited number of participants and offered minimal diagnostic significance in this study. In accordance with prior studies, platelet count alone is not a reliable indication of acute appendicitis; rather, it may serve as a supplementary measure alongside other inflammatory markers.The present analysis revealed enhanced diagnostic accuracy and a reduced rate of negative appendectomy when hematologicaland inflammatory indicators were utilized concurrently. Prior studies have shown that early diagnosis and effective surgical intervention can be enhanced by integrating test markers with comprehensive clinical evaluation. This is particularly applicable in circumstances where advanced imaging is not readily available [23, 24].

The present analysis identified hematological and inflammatory indicators as valuable adjuncts in diagnosing acute appendicitis. Among the indicators that were analyzed, the neutrophil-lymphocyte ratio showed the best diagnostic accuracy. The subsequent best indicators were C-reactive protein and total leukocyte count. The integration of these indications with clinical evaluation enhanced diagnostic confidence and reduced the incidence of negative appendicectomy.

The utilization of cost-effective, comprehensible test markers often and promptly can enhance diagnostic efficiency, facilitate superior surgical judgments, and reduce the probability of complications. Patients with suspected acute appendicitis may have improved management and outcomes through the integration of inflammatory and hematological indicators into standard diagnostic methods.

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