DOI: 10.4103/sijm.sijm_11_26 ISSN: 3050-838X

Comparison of the Diagnostic Value of Raja Isteri Pengiran Anak Saleha Appendicitis Score, Alvarado Score, and Systemic Immune-Inflammation Index in the Diagnosis of Acute Appendicitis

Muhammed Ali Balcioglu, Mustafa Polat, Ali Karakus
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Abstract

Introduction and Aim:

Acute appendicitis (AA) is one of the most common causes of emergency surgery. Misdiagnosis often leads to high rates of negative appendectomy. In addition to the Alvarado and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scores used in clinical evaluation, the systemic immune-inflammation index (SII) has recently emerged as a diagnostic biomarker. However, studies evaluating these three parameters together are scarce. This study aimed to compare the diagnostic accuracy of Alvarado, RIPASA, and SII individually and in combination.

Materials and Methods:

A total of 269 patients aged 18 years and older who presented to the Emergency Department of Hatay Mustafa Kemal University in 2024 with suspected AA were retrospectively evaluated. The control group consisted of adults presenting with abdominal pain who were diagnosed with conditions other than AA. Alvarado and RIPASA scores were calculated based on clinical and laboratory findings. SII was calculated using the formula platelet × neutrophil/lymphocyte from the complete blood count. The definitive diagnosis was established histopathologically. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of each parameter alone and in combination.

Results:

The mean age of participants was 40.78 ± 16.47 years; 46.1% were female ( n = 124) and 53.9% were male ( n = 145). Of the cases, 158 (58.7%) were diagnosed with appendicitis, while 111 (41.3%) were included in the control group. Neutrophil levels were significantly higher in the patient group ( P < 0.001). ROC analysis identified cutoff values of 3.5 (area under the curve [AUC]: 0.961) for Alvarado, 6.25 (AUC: 0.962) for RIPASA, and 1519.27 (AUC: 0.753) for SII. Pairwise combinations improved AUC values. Logistic regression analysis of all three parameters together yielded an AUC of 0.968.

Conclusion:

While the Alvarado and RIPASA scores demonstrated high diagnostic accuracy, the addition of SII further enhanced diagnostic performance. Contributing to the limited number of studies evaluating these three parameters together, our findings suggest that a combined approach can improve diagnostic reliability in clinical practice and reduce unnecessary surgeries.

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