Accuracy of Mean Platelet Volume (MPV) and Red Cell Distribution Width (RDW) for the Diagnosis of Acute Appendicitis: Evaluation of Possible New Biomarkers

  • Alireza Rastgoo-Haghi ORCID Mail Department of Pathology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
  • Parvin Pourmohammad School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
  • Mohammad-Ali Seyf-Rabiee ORCID Department of Social Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
Appendicitis, Biomarkers, Diagnosis, Erythrocyte Indices, Mean Platelet Volume


Introduction: Acute appendicitis is the most common cause of the abdominal pain in surgery. Despite its significant prevalence, the diagnosis is associated with many problems in some cases, which leads to false appendectomy. Objective: The aim of this study was to determine the validity of diagnostic tests of mean platelet volume (MPV) and red cell distribution width (RDW), as a new possible tool in the diagnosis of acute appendicitis. Methods: In this study, all patients who referred to the emergency department of Besat Hospital, Hamadan, Iran, in 2015, with abdominal pain and first impression of acute appendicitis, undergone appendectomy, were evaluated. The diagnostic markers of pre-operative and post-operative pathology and the validity of MPV and RDW were determined in diagnosis of acute appendicitis. Results: Laboratory and clinical data from 438 patients, presenting the signs and symptoms of acute appendicitis with the mean age of 26.51±13.9 years, were examined (55.6% men). The sensitivity, specificity, positive and negative predictive value of MPV in the diagnosis of acute appendicitis were 59.77, 98.66, 99.5 and 34.26 percent, and for the RDW were 57.79, 56.00, 86.07 and 21.98 percent, respectively. The area under the receiver operating characteristic (ROC) curve for RDW and MPV was 0.61and 0.90, respectively. The mean of MPV in patients with normal pathologic outcome was 9.52±1.60 and in patients with acute appendicitis was 7.51±1.22. There was a significant difference between the mean MPV in both groups (p<0.001). The mean of RDW in patients with normal pathology were 13.42±1.97 and 13.05±1.09, in patients with acute appendicitis. There was a significant difference between the mean RDW of the two groups (p=0.009). Conclusion: MPV and RDW indexes have the potential to be used by the surgeons in diagnosis of acute and perforated appendicitis, especially in adults, in order to reduce unnecessary appendectomy, but MPV is more valid in screening acute appendicitis, compared to the RDW.


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1. Zinner M. Ashley SW Maingot’s abdominal operation. USA, McGraw Hill; 2007.
2. Lee M, Paavana T, Mazari F, Wilson T. The morbidity of negative appendicectomy. Ann R Coll Surg Engl. 2014;96(7):517-20.
3. Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Pollock RE. Schwartz's principles of surgery: McGraw-Hill Professional; 2004.
4. Charfi S, Sellami A, Affes A, Yaïch K, Mzali R, Boudawara TS. Histopathological findings in appendectomy specimens: a study of 24,697 cases. Int J Colorectal Dis. 2014;29(8):1009-12.
5.Sand M, Trullen XV, Bechara FG, Pala XF, Sand D, Landgrafe G, et al. A prospective bicenter study investigating the diagnostic value of procalcitonin in patients with acute appendicitis. Eur Surg Res. 2009;43(3):291-7.
6. Tang J, Gao X, Zhi M, Zhou HM, Zhang M, Chen HW, et al. Plateletcrit: A sensitive biomarker for evaluating disease activity in Crohn's disease with low hs‐CRP. J Dig Dis. 2015;16(3):118-24.
7. Li JY, Li Y, Jiang Z, Wang RT, Wang XS. Elevated mean platelet volume is associated with presence of colon cancer. Asian Pac J Cancer Prev. 2014;15(23):10501-4.
8. Tanrikulu CS, Tanrikulu Y, Sabuncuoglu MZ, Karamercan MA, Akkapulu N, Coskun F. Mean platelet volume and red cell distribution width as a diagnostic marker in acute appendicitis. Iran Red Crescent Med J. 2014;16(5):e10211.
9. Bozlu G, Taskinlar H, Unal S, Alakaya M, Nayci A, Kuyucu N. Diagnostic value of red blood cell distribution width in pediatric acute appendicitis. Pediatr Int. 2016;58(3):202-5.
10. Narci H, Turk E, Karagulle E, Togan T, Karabulut K. The role of mean platelet volume in the diagnosis of acute appendicitis: a retrospective case-controlled study. Iran Red Crescent Med J. 2013;15(12):e11934.
11. Hershko DD, Sroka G, Bahouth H, Ghersin E. The role of selective computed tomography in the diagnosis and management of suspected acute appendicitis. Am Surg. 2002;68(11):1003-7.
12. Mohebbi HA, Mehrvarz S, Kashani MT, Kabir A, Moharamzad Y. Predicting negative appendectomy by using demographic, clinical, and laboratory parameters: A cross-sectional study. Int J Surg. 2008;6(2):115-8.
13. Mohebbi HA, Panahi F, Kabir A. Comparing presentation and diagnostic accuracy for conscripts and nonconscripts who have already been selected for appendectomy. Military medicine. 2006;171(11):1110-2.
14. Boshnak N, Boshnaq M, Elgohary H. Evaluation of platelet indices and red cell distribution width as new biomarkers for the diagnosis of acute appendicitis. Journal of Investigative Surgery. 2018;31(2):121-9.
15. Freud E, Pilpel D, Mares A. Acute appendicitis in childhood in the Negev region: some epidemiological observations over an 11-year period (1973-1983). J Pediatr Gastroenterol Nutr. 1988;7(5):680-4.
16. Guo Y, Xiao SY, Yan H, Sun ND, Jiang MS, Liu DY. Cluster of acute hemorrhagic appendicitis among high school students in Wuhan, China. Am J Surg. 2004;188(2):115-21.
17. Martin DL, Gustafson TL. A cluster of true appendicitis cases. Am J Surg. 1985;150(5):554-7.
18. Doherty G, Lewis Jr F. Appendicitis: continuing diagnostic challenge. Emerg Med Clin North Am. 1989;7(3):537-53.
19. John B, Henry J. Clinical diagnosis and management by laboratory methods. WB Saunders Company. 2001.
20. Dinc B, Oskay A, Dinc SE, Bas B, Tekin S. New parameter in diagnosis of acute appendicitis: platelet distribution width. World J Gastroenterol. 2015;21(6):1821-6.
21. Sevinç MM, Kınacı E, Çakar E, Bayrak S, Özakay A, Aren A, et al. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: an analysis of 3392 cases. Ulus Travma Acil Cerrahi Derg. 2016;22(2):155-62.
22. Saxena D, Tandon M, Gedam B. Role of Mean Platelet Volume (MPV) In Diagnosis of Acute Appendicitis. Int J Biomed Res. 2015;6(4):235-7.
23. Kucuk E, KucuK I. Mean Platelet Volume is Reduced in Acute Appendicitis. Turk J Emerg Med. 2015;15(1):23-7.
24. Fan Z, Pan J, Zhang Y, Wang Z, Zhu M, Yang B, et al. Mean Platelet Volume and Platelet Distribution Width as Markers in the Diagnosis of Acute Gangrenous Appendicitis. Dis Markers. 2015;2015:542013.
25. Bozkurt S, Köse A, Erdoğan S, Bozali Gİ, Ayrık C, Arpacı RB, et al. MPV and other inflammatory markers in diagnosing acute appendicitis. J Pak Med Assoc. 2015;65(6):637-41.
26. Aydogan A, Akkucuk S, Arica S, Karakus A, Ozkan OV, Yetim I, et al. The analysis of mean platelet volume and platelet distribution width levels in appendicitis. Indian J Surg. 2015;77(2):495-500.
27. Bilici S, Sekmenli T, Göksu M, Melek M, Avci V. Mean platelet volume in diagnosis of acute appendicitis in children. Afr Health Sci. 2011;11(3):427-32.
28. Dalal I, Somekh E, Bilker-Reich A, Boaz M, Gorenstein A, Serour F. Serum and peritoneal inflammatory mediators in children with suspected acute appendicitis. Arch Surg. 2005;140(2):169-73.
29. Grönroos J, Grönroos P. Leucocyte count and C‐reactive protein in the diagnosis of acute appendicitis. Br J Surg. 1999;86(4):501-4.
30. Uyanik B, Kavalci C, Arslan ED, Yilmaz F, Aslan O, Dede S, et al. Role of mean platelet volume in diagnosis of childhood acute appendicitis. Emerg Med Int. 2012;2012:823095.
31. Aslanabadi S, Maghsoodi H, Ghare-Daghi A, Ghasemi B, Mofidi M, Yousef-Nezhad O. Diagnostic value of WBC count and C-reactive protein for detection of acute appendicitis in children. J Qazvin Uni Med Sci. 2010;14(1):49-56.
32. Rouzrokh M, Fard FE, Momeni N, Tavassoli A. Diagnostic role of ESR, CRP, leukocytosis and Neutrophil/Lymphocyte in peripheral blood smear in children under 14 with acute appendicitis. Pajoohandeh. 2011;16(1):42-6.
33. Stefanutti G, Ghirardo V, Gamba P. Inflammatory markers for acute appendicitis in children: are they helpful? J Pediater Surg. 2007;42(5):773-6.
How to Cite
Rastgoo-Haghi A, Pourmohammad P, Seyf-Rabiee M-A. Accuracy of Mean Platelet Volume (MPV) and Red Cell Distribution Width (RDW) for the Diagnosis of Acute Appendicitis: Evaluation of Possible New Biomarkers. Adv J Emerg Med. 4(2):e20.
Original article