Comparison of Eosinophil Values with Other Biomarkers in Predicting Perforation of Acute Appendicitis

Acute appendicitis (AA) is a common cause of abdominal pain for patients presenting to emergency departments (EDs); it is the most common cause of acute abdomen-related operations (1). While the gold standard for the diagnosis of AA is physical examination and laboratory results (mainly leukocytosis), one major concern is that the symptoms and signs of AA frequently overlap those of several other acute abdominal emergencies. A delay in diagnosis and surgical intervention inevitably results in perforation, which is a leading cause of morbidity and mortality of AA. Furthermore, complications arising from AA, especially perforation, can result in dysfunction of the fallopian tubes; this usually leads to infertility (2). However, perforation in AA patients is usually diagnosed either intra-operatively by observation or post-operatively by histopathological examination. Thus, timely and accurate diagnosis of perforation is critical, as these complications can be prevented by surgical intervention and successful removal of the appendix. Many studies have examined biomarkers as diagnostic tools for the diagnosis of appendicitis; however, the number of studies investigating candidate biomarkers for prediction of perforation is limited. Akyildiz et al. (3), in their study comparing perforated and non-perforated appendicitis patients failed to demonstrate differences in leucocyte counts. Studies suggested hyperbilirubinemia as a marker for