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Assessing perforation of acute appendicitis using the delta neutrophil index reflecting the peripheral immature granulocyte count


The delta neutrophil index corresponds to the calculated immature granulocyte counts and the severity of sepsis. This study investigated the diagnostic value of the delta neutrophil index as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis.


This study was a retrospective analysis of patients confirmed as appendicitis pathologically from November 2009 to September 2010 at two hospitals. The delta neutrophil index was automatically calculated as a subset of routine complete blood count test. The diagnostic performance of the delta neutrophil index for perforated appendicitis was evaluated.


During the study period, 308 patients were enrolled. Among them, 32 patients (10.4%) were confirmed as perforated appendicitis. The delta neutrophil index was significantly higher in the perforated group than the nonperforated group (4.8 ± 7.1% vs. 2.0 ± 2.0%, P < 0.05). The sensitivity and specificity of the delta neutrophil index for predicting perforated appendicitis was 25.0% and 96.7% respectively at a cutoff level of 5% with an area under the curve of 0.78 on the ROC curve.


This study suggested that the delta neutrophil index is associated with perforated appendicitis. However, the sensitivity was not high enough to use as a clinical guidance.


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Correspondence to NG Rhee.

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Rhee, N., Chung, S. Assessing perforation of acute appendicitis using the delta neutrophil index reflecting the peripheral immature granulocyte count. Crit Care 16, P64 (2012).

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  • Emergency Medicine
  • Retrospective Analysis
  • Appendicitis
  • Blood Count
  • Diagnostic Performance