Acute appendicitis remains one of the most common surgical emergencies worldwide, yet its diagnosis can still be challenging. Clinicians typically rely on clinical assessment supported by laboratory markers such as white cell count (WCC), C-reactive protein (CRP), and neutrophil-based indices. However, these markers lack specificity and may be elevated in a variety of inflammatory conditions, contributing to diagnostic uncertainty and unnecessary surgery. As a result, there is ongoing interest in identifying more reliable biomarkers that reflect the underlying inflammatory pathology of appendicitis.
Circulating fibrocytes are bone marrow–derived cells involved in inflammation and tissue repair. Previous research has shown that CFP increases in several inflammatory and fibrotic conditions, but its role in acute appendicitis had not been evaluated before this study. The investigators aimed to assess whether CFP is elevated in patients with appendicitis and to compare its diagnostic accuracy with standard serological markers.
The study was designed as a prospective cohort investigation and was conducted between June 2015 and February 2016. A total of 95 adults were recruited, including 15 healthy volunteers and 80 patients who presented with suspected acute appendicitis. Peripheral venous blood samples were collected, and CFP was measured using fluorescence-activated cell sorting after dual staining for CD45 and collagen I. These results were then correlated with histopathological findings in patients who underwent appendicectomy.
The study led to the following findings:
- Of the 80 patients presenting with suspected acute appendicitis, 46 underwent appendicectomy, and histopathological analysis confirmed acute appendicitis in 34 cases.
- Circulating fibrocyte percentage (CFP) levels were significantly higher in patients with histologically confirmed appendicitis compared with healthy control participants.
- Median CFP values were markedly elevated in the appendicitis group, indicating a strong association between increased circulating fibrocytes and acute intra-abdominal inflammation.
- Receiver operating characteristic (ROC) curve analysis showed that the diagnostic accuracy of CFP was comparable to that of commonly used biomarkers, including white cell count, C-reactive protein, neutrophil count, lymphocyte count, and the neutrophil-to-lymphocyte ratio.
- Multinomial regression analysis demonstrated that elevated CFP was the only biomarker independently associated with histologically confirmed acute appendicitis when analyzed alongside conventional inflammatory markers.
The authors conclude that CFP is increased in patients with confirmed acute appendicitis and performs at least as well as standard serological markers for diagnostic purposes. They suggest that CFP could serve as a useful adjunct in the diagnostic work-up of suspected appendicitis, particularly in equivocal cases. Further studies in larger and more diverse populations are needed to validate these findings and explore the feasibility of incorporating CFP measurement into routine clinical practice.
Reference:
Zarog, M. A., Kiernan, M. G., Bolger, J., Tibbitts, P., Coffey, S. N., Lowery, A., Byrnes, G. J., Peirce, C., Dunne, C. P., & Coffey, J. C. (2020). Role of circulating fibrocytes in the diagnosis of acute appendicitis. BJS Open, 4(6), 1256-1265. https://doi.org/10.1002/bjs5.50350
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