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Komplike Apandisitin Belirlenmesinde Temel Laboratuvar Parametrelerinin Tanısal Değeri

Year 2024, Volume: 3 Issue: 2, 42 - 49, 30.06.2024
https://doi.org/10.59518/farabimedj.1392105

Abstract

Bu çalışmanın amacı akut apandisit nedeni ile opere edilen hastalarda laboratuvar parametrelerinin komplike apandisit öngörülmesindeki etkinliğini araştırmaktır. Appendektomi uygulanmış ve patoloji sonucu akut apandisit olarak bildirilen 153 hasta çalışmaya dahil edildi. Hastalar patoloji sonuçları ve operasyon bulgularına göre basit ve komplike apandisit olarak iki gruba ayrıldı. Hastalara ait yaş, cinsiyet, operasyon öncesi lökosit sayısı, nötrofil sayısı, nötrofil yüzdesi, nötrofil-lenfosit oranı, eritrosit dağılım genişliği, ortalama trombosit hacmi ve C-reaktif protein değerleri kaydedildi. Basit apandisit grubunda 97, komplike apandisit grubunda 56 hasta mevcuttu. Her iki grupta da erkek cinsiyet ön planda idi. Komplike apandisit gubunda yaş daha ileri idi (p=0.007). Lökosit sayısı (p<0.001), nötrofil sayısı (p=0.007), nötrofil yüzdesi (p<0.001), nötrofil-lenfosit oranı (p<0.001) ve C-reaktif protein (p<0.001) komplike apandisit grubunda istatistiksel olarak anlamlı fark oluşturacak şekilde yüksek tespit edildi. Eritrosit dağılım genişliği ve ortalama trombosit hacmi için gruplar arasında anlamlı fark yoktu. Kesim değerleri yaş için 24.5/yıl, lökosit sayısı için 12500/µL, nötrofil sayısı için 9950/µL, nötrofil yüzdesi için % 78.15, nötrofil-lenfosit oranı için 4.98 ve C-reaktif protein için 0.29 mg/dl olarak hesaplandı. Lojistik regresyon analizinde yaş (OR:1.036) nötrofil sayısı (OR: 14.934) ve C-reaktif protein (OR: 4.225) komplike apandisit tanısı için bağımsız risk faktörleri olarak tespit edildi. Yaş, nötrofil sayısı ve C-reaktif protein basit-komplike apandisit ayrımında yardımcı parametreler olarak kullanılabilir.

References

  • Fan Z, Pan J, Zhang Y, et al. Mean platelet volume and platelet distribution width as markers in the diagnosis of acute gangrenous appendicitis. Dis Markers. 2015;2015:542013. doi:10.1155/2015/542013
  • Akyüz M, Topal U, Gök M, Öz B, İsaoğulları ŞY, Sözüer EM. Predictive value of neutrophil/lymphocyte ratios in the diagnosis of acute appendicitis. Med J Bakirkoy. 2020;16(1):76-84. doi:10.5222/BMJ.2020.18480
  • Dickerson TL, Horattas MC. What have we learned over the past 20 years about appendicitis in the elderly?. Am J Surg. 2003;185(3):198-201. doi:10.1016/S0002-9610(02)01390-9
  • Bedel C. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis. Turk J Clin Lab. 2018;9(4):266-271. doi:10.18663/tjcl.392577
  • Harnoss JC, Zelienka I, Probst P, et al. Antibiotics versus surgical therapy for uncomplicated appendicitis: Systematic review and meta-analysis of controlled trials (PROSPERO 2015: CRD42015016882). Ann Surg. 2017;265(5):889-900. doi:10.1097/SLA.0000000000002039
  • Di Saverio S, Sibilio A, Giorgini E, et al. The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis. Ann Surg. 2014;260(1):109-117. doi:10.1097/SLA.0000000000000560
  • Di Saverio S, Birindelli A, Kelly MD, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016;11(1):1-25. doi:10.1186/s13017-016-0090-5
  • Atema JJ, van Rossem CC, Leeuwenburgh MM, Stoker J, Boermeester MA. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg. 2015;102(8):979-990. doi:10.1002/bjs.9835
  • Xiong B, Zhong B, Li Z, et al. Diagnostic accuracy of noncontrast ct in detecting acute appendicitis: A Meta-analysis of prospective studies. Am Surg. 2015;81(6):626-629. doi:10.1177/000313481508100629
  • Yazar FM, Urfalioglu A, Bakacak M, Boran ÖF, Bülbüloğlu E. Efficacy of the evaluation of inflammatory markers for the reduction of negative appendectomy rates. Indian J Surg. 2018;80(1):61-67. doi:10.1007/s12262-016-1558-y
  • Günay Y, Taşdöven İ, Kozan R, Koca Ş, Çağlar E. Investigation of predictive value of complete blood count in the diagnosis of acute complicated appendicitis. Med Bull Haseki. 2019;57(1):26-31. doi:10.4274/haseki.galenos.2018.4567
  • Raza M, Gupta M. Predictive value of hyperbilirubinemia, platelet distribution width and mean platelet volume in acute appendicitis and its complications. Int J Surg Sci. 2019;3(4):157-160. doi:10.33545/surgery.2019.v3.i4c.235
  • Celik B, Nalcacioglu H, Ozcatal M, Altuner Torun Y. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department. Ulus Travma Acil Cerrahi Derg. 2019;25(3):222-228. doi:10.5505/tjtes.2018.06709
  • Şahbaz NA, Bat O, Kaya B, et al. The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis. Ulus Travma Acil Cerrahi Derg. 2014;20(6):423-426. doi:10.5505/tjtes.2014.75044
  • Yigit Y, Yilmaz S, Ozbek AE, Karakayalı O, Cetin B, Halhalli HC. Can platelet indices reduce negative appendectomy rates? Cureus. 2019;11(3):e4293. doi:10.7759/cureus.4293
  • Narci H, Turk E, Karagulle E, Togan T, Karabulut K. The role of red cell distribution width in the diagnosis of acute appendicitis: a retrospective case-controlled study. World J Emerg Surg. 2013;8(1):46. doi:10.1186/1749-7922-8-46
  • Salminen P, Paajanen H, Rautio T, et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA. 2015;313(23):2340-2348. doi:10.1001/jama.2015.6154
  • Sevinç MM, Kınacı E, Çakar E, et al. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: an analysis of 3392 cases. Ulus Travma Acil Cerrahi Derg. 2016;22(2):155-162. doi:10.5505/tjtes.2016.54388
  • Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2012;97(4):299-304. doi:10.9738/CC161.1
  • Aydogan A, Akkucuk S, Arica S, Motor S, Karakus A, Ozkan OV, Yetim I, Temiz M. The Analysis of mean platelet volume and platelet distribution width levels in appendicitis. Indian J Surg. 2015 Dec;77(Suppl 2):495-500. doi: 10.1007/s12262-013-0891-7
  • Ayrık C, Karaaslan U, Dağ A, Bozkurt S, Toker İ, Demir F. Lökosit sayısı, yüzde nötrofil oranı ve C-reaktif protein konsantrasyonlarının “kesim değeri” düzeylerinde apandisit tanısındaki değerleri. Ulus Travma Acil Cerrahi Derg. 2016;22(1):76-83. doi:10.5505/tjtes.2015.91112
  • Ertekin B, Hasan K, Erdemir E, Doğan E, Acar T, Demir LS. Efficacy of use of red cell distribution width as a diagnostic marker in acute appendicitis. Eurasian J Emerg Med. 2017;16(1):29-33. doi:10.5152/eajem.2017.75047
  • Beecher SM, Hogan J, O'Leary DP, McLaughlin R. An appraisal of inflammatory markers in distinguishing acute uncomplicated and complicated appendicitis. Dig Surg. 2016;33(3):177-181. doi:10.1159/000444101
  • Yokoyama S, Takifuji K, Hotta T, et al. C-Reactive protein is an independent surgical indication marker for appendicitis: A retrospective study. World J Emerg Surg. 2009;4(1):36-40. doi:10.1186/1749-7922-4-36
  • Al-Gaithy ZK. Clinical value of total white blood cells and neutrophil counts in patients with suspected appendicitis: retrospective study. World J Emerg Surg. 2012;7(1):32-38. doi:10.1186/1749-7922-7-32
  • Kahramanca Ş, Özgehan G, Şeker D, et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. TJTES. 2014;20(1):19-22. doi:10.5505/tjtes.2014.20688
  • Shimizu T, Ishizuka M, Kubota K. A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis. Surg Today. 2016(1);46:84-89. doi:10.1007/s00595-015-1125-3
  • Yardımcı S, Uğurlu MÜ, Coşkun M, Attaallah W, Yeğen ŞC. Neutrophil-lymphocyte ratio and mean platelet volume can be a predictor for severity of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2016;22(2):163-168. doi:10.5505/tjtes.2015.89346
  • Aktimur R, Cetinkunar S, Yildirim K, Ozdas S, Aktimur SH, Gokakin AK. Mean platelet volume is a significant biomarker in the differential diagnosis of acute appendicitis. Inf Cell Sig. 2015;2:e930. doi:10.14800/ics.930
  • Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Laboratory tests in patients with acute appendicitis. ANZ J Surg. 2006;76(1):71-74. doi:10.1111/j.1445-2197.2006.03645.x
  • Asfar S, Safar H, Khoursheed M, Dashti H, Al-Bader A. Would measurement of C-reactive protein reduce the rate of negative exploration for acute appendicitis? J R Coll Surg Edinb. 2000;45(1):21-24.
  • Käser SA, Fankhauser G, Willi N, Maurer CA. C-reactive protein is superior to bilirubin for anticipation of perforation in acute appendicitis. Scand J Gastroenterol. 2010;45(7):885-892. doi:10.3109/00365521003728572

Diagnostic Value of Basic Laboratory Parameters in the Diagnosis of Complicated Appendicitis

Year 2024, Volume: 3 Issue: 2, 42 - 49, 30.06.2024
https://doi.org/10.59518/farabimedj.1392105

Abstract

In this investigation, we sought to examine the efficacy of laboratory parameters in predicting complicated appendicitis in patients who had surgery for acute appendicitis. 153 patients who underwent appendectomy were included and whose pathological results showed acute appendicitis. The patients were divided into two groups based on pathology findings and surgical findings: simple and complicated appendicitis groups. The patients’ age, gender, preoperative leukocyte count, neutrophil count, neutrophil percentage, neutrophil–lymphocyte ratio, erythrocyte distribution width, mean platelet volume, and C-reactive protein levels were recorded. The simple and complicated appendicitis groups comprised 97 and 56 patients, respectively. Patients with complicated appendicitis were older on average than those with simple appendicitis (p=0.007). In the complicated appendicitis group, leukocyte count (p<0.001), neutrophil count (p=0.007), neutrophil percentage (p<0.001), neutrophil–lymphocyte ratio (p<0.001), and C-reactive protein levels (p<0.001) were significantly higher than in the simple appendicitis group. In terms of erythrocyte distribution width and mean platelet volume, there were no statistically significant differences between the groups. The cut-off values for age, leukocyte count, neutrophil count, neutrophil percentage, neutrophil–lymphocyte ratio, and C-reactive protein levels were 24.5/years, 12.500/µL, 9.950/µL, 78.15%, 4.98, and 0.29 mg/dL, respectively. Logistic regression analysis showed that age (OR: 1.036), neutrophil count (OR: 14.934), and C-reactive protein levels (OR: 4.225) are independent risk factors for the diagnosis of complicated appendicitis. Thus, age, neutrophil count, and C-reactive protein levels may be used as auxiliary parameters to differentiate between simple and complicated appendicitis.

Ethical Statement

None of the authors have potential conflicts of interest to be disclosed.

Supporting Institution

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Thanks

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References

  • Fan Z, Pan J, Zhang Y, et al. Mean platelet volume and platelet distribution width as markers in the diagnosis of acute gangrenous appendicitis. Dis Markers. 2015;2015:542013. doi:10.1155/2015/542013
  • Akyüz M, Topal U, Gök M, Öz B, İsaoğulları ŞY, Sözüer EM. Predictive value of neutrophil/lymphocyte ratios in the diagnosis of acute appendicitis. Med J Bakirkoy. 2020;16(1):76-84. doi:10.5222/BMJ.2020.18480
  • Dickerson TL, Horattas MC. What have we learned over the past 20 years about appendicitis in the elderly?. Am J Surg. 2003;185(3):198-201. doi:10.1016/S0002-9610(02)01390-9
  • Bedel C. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis. Turk J Clin Lab. 2018;9(4):266-271. doi:10.18663/tjcl.392577
  • Harnoss JC, Zelienka I, Probst P, et al. Antibiotics versus surgical therapy for uncomplicated appendicitis: Systematic review and meta-analysis of controlled trials (PROSPERO 2015: CRD42015016882). Ann Surg. 2017;265(5):889-900. doi:10.1097/SLA.0000000000002039
  • Di Saverio S, Sibilio A, Giorgini E, et al. The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis. Ann Surg. 2014;260(1):109-117. doi:10.1097/SLA.0000000000000560
  • Di Saverio S, Birindelli A, Kelly MD, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016;11(1):1-25. doi:10.1186/s13017-016-0090-5
  • Atema JJ, van Rossem CC, Leeuwenburgh MM, Stoker J, Boermeester MA. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg. 2015;102(8):979-990. doi:10.1002/bjs.9835
  • Xiong B, Zhong B, Li Z, et al. Diagnostic accuracy of noncontrast ct in detecting acute appendicitis: A Meta-analysis of prospective studies. Am Surg. 2015;81(6):626-629. doi:10.1177/000313481508100629
  • Yazar FM, Urfalioglu A, Bakacak M, Boran ÖF, Bülbüloğlu E. Efficacy of the evaluation of inflammatory markers for the reduction of negative appendectomy rates. Indian J Surg. 2018;80(1):61-67. doi:10.1007/s12262-016-1558-y
  • Günay Y, Taşdöven İ, Kozan R, Koca Ş, Çağlar E. Investigation of predictive value of complete blood count in the diagnosis of acute complicated appendicitis. Med Bull Haseki. 2019;57(1):26-31. doi:10.4274/haseki.galenos.2018.4567
  • Raza M, Gupta M. Predictive value of hyperbilirubinemia, platelet distribution width and mean platelet volume in acute appendicitis and its complications. Int J Surg Sci. 2019;3(4):157-160. doi:10.33545/surgery.2019.v3.i4c.235
  • Celik B, Nalcacioglu H, Ozcatal M, Altuner Torun Y. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department. Ulus Travma Acil Cerrahi Derg. 2019;25(3):222-228. doi:10.5505/tjtes.2018.06709
  • Şahbaz NA, Bat O, Kaya B, et al. The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis. Ulus Travma Acil Cerrahi Derg. 2014;20(6):423-426. doi:10.5505/tjtes.2014.75044
  • Yigit Y, Yilmaz S, Ozbek AE, Karakayalı O, Cetin B, Halhalli HC. Can platelet indices reduce negative appendectomy rates? Cureus. 2019;11(3):e4293. doi:10.7759/cureus.4293
  • Narci H, Turk E, Karagulle E, Togan T, Karabulut K. The role of red cell distribution width in the diagnosis of acute appendicitis: a retrospective case-controlled study. World J Emerg Surg. 2013;8(1):46. doi:10.1186/1749-7922-8-46
  • Salminen P, Paajanen H, Rautio T, et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA. 2015;313(23):2340-2348. doi:10.1001/jama.2015.6154
  • Sevinç MM, Kınacı E, Çakar E, et al. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: an analysis of 3392 cases. Ulus Travma Acil Cerrahi Derg. 2016;22(2):155-162. doi:10.5505/tjtes.2016.54388
  • Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2012;97(4):299-304. doi:10.9738/CC161.1
  • Aydogan A, Akkucuk S, Arica S, Motor S, Karakus A, Ozkan OV, Yetim I, Temiz M. The Analysis of mean platelet volume and platelet distribution width levels in appendicitis. Indian J Surg. 2015 Dec;77(Suppl 2):495-500. doi: 10.1007/s12262-013-0891-7
  • Ayrık C, Karaaslan U, Dağ A, Bozkurt S, Toker İ, Demir F. Lökosit sayısı, yüzde nötrofil oranı ve C-reaktif protein konsantrasyonlarının “kesim değeri” düzeylerinde apandisit tanısındaki değerleri. Ulus Travma Acil Cerrahi Derg. 2016;22(1):76-83. doi:10.5505/tjtes.2015.91112
  • Ertekin B, Hasan K, Erdemir E, Doğan E, Acar T, Demir LS. Efficacy of use of red cell distribution width as a diagnostic marker in acute appendicitis. Eurasian J Emerg Med. 2017;16(1):29-33. doi:10.5152/eajem.2017.75047
  • Beecher SM, Hogan J, O'Leary DP, McLaughlin R. An appraisal of inflammatory markers in distinguishing acute uncomplicated and complicated appendicitis. Dig Surg. 2016;33(3):177-181. doi:10.1159/000444101
  • Yokoyama S, Takifuji K, Hotta T, et al. C-Reactive protein is an independent surgical indication marker for appendicitis: A retrospective study. World J Emerg Surg. 2009;4(1):36-40. doi:10.1186/1749-7922-4-36
  • Al-Gaithy ZK. Clinical value of total white blood cells and neutrophil counts in patients with suspected appendicitis: retrospective study. World J Emerg Surg. 2012;7(1):32-38. doi:10.1186/1749-7922-7-32
  • Kahramanca Ş, Özgehan G, Şeker D, et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. TJTES. 2014;20(1):19-22. doi:10.5505/tjtes.2014.20688
  • Shimizu T, Ishizuka M, Kubota K. A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis. Surg Today. 2016(1);46:84-89. doi:10.1007/s00595-015-1125-3
  • Yardımcı S, Uğurlu MÜ, Coşkun M, Attaallah W, Yeğen ŞC. Neutrophil-lymphocyte ratio and mean platelet volume can be a predictor for severity of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2016;22(2):163-168. doi:10.5505/tjtes.2015.89346
  • Aktimur R, Cetinkunar S, Yildirim K, Ozdas S, Aktimur SH, Gokakin AK. Mean platelet volume is a significant biomarker in the differential diagnosis of acute appendicitis. Inf Cell Sig. 2015;2:e930. doi:10.14800/ics.930
  • Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Laboratory tests in patients with acute appendicitis. ANZ J Surg. 2006;76(1):71-74. doi:10.1111/j.1445-2197.2006.03645.x
  • Asfar S, Safar H, Khoursheed M, Dashti H, Al-Bader A. Would measurement of C-reactive protein reduce the rate of negative exploration for acute appendicitis? J R Coll Surg Edinb. 2000;45(1):21-24.
  • Käser SA, Fankhauser G, Willi N, Maurer CA. C-reactive protein is superior to bilirubin for anticipation of perforation in acute appendicitis. Scand J Gastroenterol. 2010;45(7):885-892. doi:10.3109/00365521003728572
There are 32 citations in total.

Details

Primary Language English
Subjects Surgery (Other)
Journal Section Research Articles
Authors

Mehmet Uluşahin 0000-0002-0212-2103

Ahmet Ünal 0000-0001-5421-7588

Serdar Türkyılmaz 0000-0002-2619-3336

Publication Date June 30, 2024
Submission Date November 16, 2023
Acceptance Date February 23, 2024
Published in Issue Year 2024 Volume: 3 Issue: 2

Cite

AMA Uluşahin M, Ünal A, Türkyılmaz S. Diagnostic Value of Basic Laboratory Parameters in the Diagnosis of Complicated Appendicitis. Farabi Med J. June 2024;3(2):42-49. doi:10.59518/farabimedj.1392105

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