Diagnostic Accuracy of Ischemia-modified Albumin in Complicated Appendicitis and Its Comparison with the Conventional Markers: An Observational Study

Background: Acute appendicitis is a common emergency, with one-third presenting as complicated cases. Differentiating complicated appendicitis (CA) from uncomplicated appendicitis (UA) is important to decide on intervention. Conventional markers have limitations, while ischemia-modified albumin (IMA), released during ischemia and oxidative stress, may aid in diagnosis. This study evaluates the utility of IMA in distinguishing CA from UA. Materials and Methods: An observational cross-sectional study conducted in a tertiary care hospital on 85 patients over 13 years with acute appendicitis was further divided into CA ( n = 42) and UA ( n = 43) based on ultrasonography and histopathology findings. Total leukocyte count (TLC), differential count, neutrophil lymphocyte ratio (NLR), modified Alvarado Scoring (MAS), and IMA were estimated and compared between the groups. Sensitivity, specificity, and cutoff were established for the parameters using the area under the curve for the diagnosis of CA. Pearson’s correlation analysis of IMA with the parameters was also done. Results: IMA levels were significantly higher in CA 10.90 ± 5.65 μg/mL compared to UA 6.00 ± 2.93 μg/mL ( P = 0.001). It showed a high sensitivity (82.35%) and specificity (95.56%) with a high AUC (0.904) at a cutoff of 8.50 μg/mL in a 95% confidence interval of 0.8871–0.9219 compared to other parameters such as TLC, NLR, and MAS scoring. Furthermore, a significant positive correlation with TLC ( r = 0.7463) and a moderate correlation with NLR ( r = 0.5266) suggest that elevated IMA levels parallel inflammation in CA. Conclusion: IMA appears to be an ideal parameter to identify CA; however, larger multicentric studies are required to validate its clinical utility.