ORIGINAL RESEARCH article

Front. Immunol.

Sec. Systems Immunology

Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1620459

This article is part of the Research TopicSystems Immunology and Translational Research in Infectious DiseasesView all 8 articles

Systemic Inflammatory Indices and Age-Dependent Severity in Acute Appendicitis: A Retrospective Cohort Study

Provisionally accepted
Catalin Vladut Ionut FeierCatalin Vladut Ionut Feier1,2Andrei MotocAndrei Motoc3*Muntean CMuntean C4*Razvan Constantin VonicaRazvan Constantin Vonica5Vasile GaboreanVasile Gaborean6Sorin OlariuSorin Olariu2Marius-Sorin MurariuMarius-Sorin Murariu2
  • 1Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
  • 2Abdominal Surgery and Phlebology Research Center, Victor Babeș University of Medicine and Pharmacy, 300041 Timisoara, Romania, Timisoara, Romania
  • 3Department of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania, Timisoara, Romania
  • 4Medical Informatics and Biostatistics, Department III-Functional Sciences, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041, Timisoara, Romania
  • 5Preclinical Department, Discipline of Physiology, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania, Sibiu, Romania
  • 6Thoracic Surgery Research Center, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041 Timişoara, Romania, Timisoara, Romania

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Background: Acute appendicitis (AA) remains the most common cause of emergency abdominal surgery, yet achieving precise preoperative risk stratification is still challenging, particularly among elderly patients. Recent interest has focused on systemic inflammatory biomarkers and the role of immunosenescence in influencing disease progression. Materials and Methods: We retrospectively analyzed 407 adult patients who underwent appendectomy over a six-year period at a tertiary hospital. Patients were grouped by age and histopathological subtype. Preoperative blood counts were used to calculate systemic inflammatory indices, including NLR, PLR, SII, SIRI, and AISI. Associations between biomarkers and histopathological severity were assessed using multivariable multinomial logistic regression, with adjustments for age and hospitalization duration. Results: Higher neutrophil counts and elevated PLR were significantly associated with gangrenous appendicitis (p < 0.001 and p = 0.047, respectively). Increased SIRI and neutrophil levels predicted phlegmonous appendicitis (p = 0.020 and p < 0.001). Age independently correlated with more severe histopathological forms. Distinct variations in inflammatory profiles were observed across different age groups and histological categories. Conclusion: Systemic inflammatory indices, particularly NLR, PLR, SII, and SIRI, hold considerable promise for enhancing preoperative stratification in acute appendicitis. Their integration into clinical practice could improve diagnostic accuracy, especially in older patients affected by immunosenescence.

Keywords: acute appendicitis, Systemic inflammatory biomarkers, immunosenescence, systemic immune-inflammation index, Platelet-to-lymphocyte ratio Writingoriginal draft, methodology, investigation, Conceptualization. CM: Writingreview & editing

Received: 29 Apr 2025; Accepted: 09 Jun 2025.

Copyright: © 2025 Feier, Motoc, C, Vonica, Gaborean, Olariu and Murariu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Andrei Motoc, Department of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania, Timisoara, Romania
Muntean C, Medical Informatics and Biostatistics, Department III-Functional Sciences, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041, Timisoara, Romania

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Supplementary Material