Diagnostic value of serum fibrinogen as a predictive factor for complicated appendicitis (perforated). A cross-sectional study

• AA is the most common indication for emergency abdominal surgery without a diagnostic method for complicated appendicitis.
• Serological methods to estimate the severity of acute appendicitis are currently of interest.
• The serum fibrinogen is a possible, easy, and accessible marker that can predict a complicated appendicitis.
• We demonstrate that serum fibrinogen has a high sensitivity and specificity for complicated appendicitis.

BackgroundAcute appendicitis (AA) has a prevalence of 8% in the general population with a rate of complicated (perforated) appendicitis (CA) up to 40%. Serum fibrinogen may serve as an indicator for CA.Patients and Methods115 patients were included from January 2012 to December 2012 using a positive pathology report for AA as a gold standard diagnostic method. We divided the patients into two groups accordingly to the pathology report: Complicated Appendicitis and Uncomplicated Appendicitis (UA). Our primary endpoint was to compare the levels of serum fibrinogen between the two groups and find if there is a relationship between fibrinogen level and CA.Results68 patients were diagnosed with UA and 47 with CA. Using a fibrinogen value of 885 mg/dl we found to be the best cut-off for predicting complicated appendicitis with a sensitivity of 86.77% (76.87–93.71 IC 95%), a specificity of 91.49 (83.51–99.46 IC 95%), a positive predictive value of 93.65 (95% CI 86.81–99.64) and, a negative predictive value of 82.69 (95% CI 65.73–87.84).ConclusionIn the setting of a patient with a clinical diagnosis of AA, this study demonstrates fibrinogen as a good predictor factor for appendiceal perforation.