Systemic immune inflammation index may be a new powerful marker for the accurate early prediction of complications in patients with acute appendicitis

Yıl 2023, Cilt: 48 Sayı: 2, 679 - 685, 02.07.2023

Hüseyin Mutlu , Ekrem Taha Sert , Kamil Kokulu , Yakup Uslu

https://doi.org/10.17826/cumj.1276128

Öz

Purpose: To investigate the relationship between the systemic immune-inflammatory index (SII) and acute appendicitis (AA).
Materials and Methods: We retrospectively evaluated patients aged over 18 years who were diagnosed with AA and underwent surgery at our clinic from January 1, 2019, through July 31, 2022. The patients were divided into three groups: complicated acute appendicitis (CAA), uncomplicated acute appendicitis (UAA), and control. The clinical and laboratory characteristics of the patients evaluated at the emergency department were recorded. The neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and SII (neutrophil count x platelet count/lymphocyte count) were calculated.
Results: The study included a total of 1,456 patients, of whom 628 had UAA, 104 had CAA, and 714 were controls. The NLR, PLR, and SII values were statistically significantly higher in the CAA group than in the control group and the UAA group. The multivariate logistic regression analysis revealed that SII was an independent predictor of CAA development (odds ratio [OR]: 4.65; 95% confidence interval [CI]: 2.31–10.17). The predictive power of SII in the prediction of CAA (area under the curve [AUC]: 0.809) was much higher than that of NLR (AUC: 0.729), neutrophil count (AUC: 0.696), and C-reactive protein (AUC: 0.732) alone. It was determined that an SII value greater than 1,989.2 had a sensitivity of 78.4% and a specificity of 88.5% in predicting CAA development.
Conclusion: SII is a simple, inexpensive, and promising marker that could predict both the diagnosis and severity of appendicitis.

Anahtar Kelimeler

systemic immune-inflammatory index, acute appendicitis, emergency department

Sistemik immün inflamasyon indeksi, akut apandisitli hastalarında komlikasyonun doğru erken tahmini için yeni ve güçlü bir belirteç olabilir

Öz

Amaç: Bu çalışmada, sistemik immün-inflamatuar indeks (SII) ile Akut Apandisit (AA) arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: 1 Ocak 2019-31 Temmuz 2022 tarihleri arasında kliniğimizde AA tanısı konup ameliyat edilen, 18 yaş üstü hastaları retrospektif olarak analiz ettik. Hastalar; Complicated Akut apandisit (CAA), Uncomplicated Akut Apandisit (UAA) ve kontrol grubu olarak üçe ayrıldı. Hastaların Acil servisteki klinik ve laboratuvar özellikleri değerlendirildi. Hastaların nötrofil/lenfosit oranı (NLR) ve trombosit/lenfosit oranı (PLR) ve SII (nötrofil sayısı x trombosit sayısı /lenfosit sayısı) hesaplandı.
Bulgular: Çalışmaya 628 UAA, 104 CAA hastası ve 714 kontrol grubu olmak üzere toplam 1456 hasta dahil edildi. NLR, PLR ve SII değerleri CAA grubunda, UAA grubundan kontrol grubundan istatistiksel olarak anlamlı derecede yüksek bulundu. Multivariate lojistik regresyon analizi; SII’nın (odds ratio [OR]: 4.65; 95% confidence interval [CI]: 2.31–10.17). CAA gelişimi için bağımsız prediktör olduğunu gösterdi. SII (AUC: 0.809)’in CAA’yı tahmin etme gücünü, tek başına NLR (AUC: 0.729), Neutrophil (AUC: 0.696) ve CRP ‘den (AUC: 0.732) çok daha yüksek olarak tespit ettik.1989.2’den daha yüksek SII değerleri CAA gelişimini %78,4 duyarlılık ve %88,5 özgüllük ile öngördü
Sonuç: Bulgularımız, SII'nin apandisit tanısını ve ciddiyetini öngörebilen basit, ucuz, kolay ve umut verici bir belirteç olduğunu gösterdi.

Anahtar Kelimeler

Sistemik immün-inflamatuar indeks, akut apandisit, acil servis

Kaynakça

• Dal F, Çiçek Y, Pekmezci S, Kocazeybek B, Tokman HB, Konukoglu D et al. Role of Alvarado score and biological indicators of C-reactive protein, procalicitonin and neopterin in diagnosis of acute appendicitis.Ulus Travma Acil Cerrahi Derg. 2019;25:229-37.
• Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F et al.: Epidemiology and outcomes of acuteabdominal pain in a large urban emergency department: retrospective analysis of 5,340 cases. Ann Transl Med. 2016;4:362.
• Storm-Dickerson TL, Horattas MC. What have we learned over the past 20 yearsabout appendicitis in the elderly? Am J Surg. 2003;185:198e201.
• Doherty, G. M., & Way, L. W. (Eds.).Current diagnosis & treatment: surgery. New York, NY, USA: Lange Medical Books/McGraw-Hill. 2010; 493-498.
• Papandria D, Goldstein SD, Rhee D, Salazar J H, Arlikar J, Gorgy A, et al.: Risk of perforation increases with delay in recognition and surgery for acute appendicitis. J Surg Res. 2013;184:723-29.
• Beecher S, O’Leary DP, McLaughlin R: Hospital tests and patient related factors influencing time-to-theatre in 1000 cases of suspected appendicitis: a cohort study. World J Emerg Surg. 2015;10:6.
• Lietzén E, Salminen P, Rinta-Kiikka I, Paajanen H, Rautio T, Nordström P, Grönroos JM et al.: The accuracy of the computed tomography diagnosis of acute appendicitis: does the experience of the radiologist matter?. Scand J Surg. 2018;107:43-47.
• Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: a systematic review and meta-analysis. Am J Surg., 2020;219:154-163.
• Kariman H, Shojaee M, Sabzghabaei A, Khatamian R, Derakhshanfar H, Hatamabadi H. Evaluation of the Alvarado score in acute abdominal pain. UlusTravma Acil Cerrahi Derg. 2014;20:86e90.
• Sand M, Bechara FG, Holland-Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg. 2009;198:193e198.
• Guraya SY, Al-Tuwaijri TA, Khairy GA, Murshid KR. Validity of leukocyte count to predict the severity of acute appendicitis. Saudi Med J. 2005;26:1945e1947.
• Coleman C, Thompson Jr ,J.E., Bennion RS, Schmit PJ. White blood cell count is a poor predictor of severity of disease in the diagnosis of appendicitis. Am Surg. 1998;64:983e985.
• Adams HL, Jaunoo SS. Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation. Eur J Trauma Emerg Surg. 2016;42:249e252.
• Silva FR, da Rosa MI, Silva BR, Simon C, Alexandre M.C, Medeiros L.R et al. Hyperbilirubinaemia alone cannot distinguish a perforation in acute appendicitis. ANZ J Surg. 2016;86:255e259.
• Kokulu K, Günaydın YK, Akıllı NB, Köylü R, Sert ET, Köylü Ö et al. The Relationship between the neutrophil-to-lymphocyte ratio in acute pancreatitis and the severity and systemic complications of the disease. Turk J Gastroenterol 2018;29:684-91.
• Rajalingam VR, Mustafa A, Ayeni A, Mahmood F, Shammout S, Singhal S et al: The role of neutrophil-lymphocyte-ratio (NLR) and platelet-lymphocyte-ratio (PLR) as a biomarker for distinguishing between complicated and uncomplicated appendicitis. Cureus. 2022, 14:e21446. 10.7759/cureus.21446.
• Acarturk G, Acay A, Demir K, Ulu MS, Ahsen A, Yuksel S. Neutrophil-tolymphocyte ratio in inflammatory bowel disease e as a new predictor of disease severity. Bratisl Lek Listy. 2015;116:213e217.
• Wu J, Yan L, Chai K. Systemic immune‐inflammation index is associated with disease activity in patients with ankylosing spondylitis. J Clin Lab Anal. 2021:35:e23964.
• Özdemir S, Altunok İ, Özkan A, İslam MM, Algın A, Eroğlu SE et al: The role of the hematological inflammatory index and systemic immuno-inflammation index in acute cholecystitis. European Journal of Clinical and Experimental Medicine. 2022:20:330-5.
• Duyan M, Vural N. Assessment of the diagnostic value of novel biomarkers in adult patients with acute appendicitis: a cross-sectional study. Cureus. 2022;14:e32307.
• Sevinç M M, Kınacı E, Çakar E, Bayrak S, Özakay A, Aren A et al: Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: an analysis of 3392 cases. Ulus Travma Acil Cerrahi Derg. 2016:22:155-62.
• Şahbaz NA, Bat O, Kaya B, Ulukent SC, İlkgül Ö, Özgün MY 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;20:423–6.
• Xharra S, Gashi-Luci L, Xharra K, Veselaj F, Bicaj B, Sada F et al: Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acuteappendicitis. World J Emerg Surg. 2012:7:27.
• Muller S, Falch C, Axt S, Wilhelm P, Hein D, Königsrainer A et al: Diagnostic accuracy of hyperbilirubinaemia in anticipating appendicitis and its severity. Emerg Med J. 2015, 32:698-702.
• Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2012;97:299–304.
• Lagunas-Alvarado M, Mijangos-Huesca FJ, Terán-González JO, Lagunas-Alvarado MG, Martínez-Zavala N, Reyes-Franco I et al: Índice de inmunidad-inflamación sistémica en sepsis. Medicina interna de México. 2017:33:303-9.
• Tanacan E, Dinçer D, Erdogan FG, Gurler, A. A cutoff value for the Systemic Immune‐Inflammation Index in determining activity of Behçet disease. Clinical and experimental dermatology. 2021:46:286-91.
• Ustundag Y, Huysal K, Gecgel SK, Unal, D. Relationship between C-reactive protein, systemic immune-inflammation index, and routine hemogram-related inflammatory markers in low-grade inflammation. Int J Med Biochem. 2018:1:24-8.
• Akça Hş, Algin A, Özdemir S, Yilmaz B, Altunok İ. Evaluation of the relationship of hemogram parameters with prognosis in older adults with acute abdominal pathologies. Journal of Health Sciences and Medicine. 2022:5:385-92.