C-reactive protein and red cell distribution width as indicators of complications in patients with acute appendicitis

Abstract

Aim: Acute appendicitis is one of the most common operations in general surgery. When complicated, mortality and morbidity increases. We aimed to find out whether use of C-reactive protein (CRP) and red cell distribution width (RDW) may help to find out development of complications with acute  appendicitis at initial evaluation in an emergency department.

Methods: Files of the patients who underwent operations for acute appendicitis between January 2017 and August 2017 were reviewed. Development of complications was recorded and the patients were grouped as with and without complications and were compared about age, sex RDW, CRP, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Diagnostic efficiency of CRP and RDW on the development of complications in acute appendicitis was investigated with regression analysis and by receiver operator characteristic curve analysis.

Results: Age, CRP and RDW were found to be significantly related to perforation (p<0.001 for all) (Bonferoni correction), while white blood cell (WBC), AST and ALT were found to be insignificant (p=0.052, p=0.806 and p=0.804, respectively. There was a significant correlation between RDW and CRP in the Spearman non-parametric correlation analysis (correlation coefficient r=0.244 and p<0.001). There was no significant correlation of WBC to CRP and RDW.

Conclusion: CRP and RDW are biochemical parameters that help us to identify the development of complications in acute appencitis. CRP may be elevated in acute appendicitis; however, it must be kept in mind to be cautious about a potentially complicated acute appendicitis after a certain level, RDW in our study has been found to be elevated in complicated appendicitis cases; but, it  may not helpful to detect for perforated or gangrenous appendicitis.

Keywords

• acute appendicitis,hematologic tests,laboratory analysis,complications

Akut apandisit tanısı konmuş hastalarda komplikasyon belirteçleri olarak C-reaktif protein ve kırmızı küre dağılım indisinin yeri ve önemi

Öz

 Amaç: Akut apandisit genel cerrahide en sık karşılaşılan operasyon sebeplerinden  biridir.  Komplike olduğu zaman mortalite ve morbidite artmaktadır. C-reaktif protein (CRP) ve kırmızı küre genişlik dağılım indisi (RDW) değerlerinin kullanılması komplike olan akut apandisit vakalarını acil servisteki ilk muayenede ayırt etmemizde faydalı olup olmadığını incelemeyi amaçladık.

Yöntemler: Ocak  2017 ve Ağustos 2017 tarihleri arasında akut apandisit nedeniyle opere edilmiş olan hastaların dosyaları tarandı. Hastalar yaş, cinsiyet, CRP, RDW, alanin aminotrasferaz, aspartat aminotransferaz değerleri açısından komplike olan ve olmayan akut apandisit vakalarında karşılaştırıldı. Artmış serum CRP ve RDW değerlerinin komplike apandisit tanısı koymada ne kadar etkin olduğu regresyon analizi ve alıcı işlemci karakteristiği eğrisi analizi ile değerlendirildi.

Bulgular: Yaş, RDW ve CRP, perforasyon ve gangrenöz apandisit ile belirgin olarak ilişkili olarak bulundu, p<0,001, beyaz küre, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT) düzeyleri ise P değerleri açısından anlamsız olarak bulundu (sırasıyla p=0,052, p=0,806 ve p=0,804). RDW ile CRP arasında korelasyon olmakla birlikte (korelasyon katsayısı r=0,244 ve p<0,001), beyaz küre ile RDW ve CRP arasında anlamlı bir ilişki yoktu.

Sonuç: CRP ve RDW komplike apandisit tanısını koymamızda biyokimsasal parametre olarak değerlendirilmelidir. CRP akut apandisit vakalarında artmış olarak tespit edilebilir ancak belli bir seviyeden sonra komplike olmuş bir apandisite işaret edebilir. RDW bizim çalışmamızda komplike apandisitlerde artmış olarak bulundu. Ancak bu yükseklik için bir eşik değer tespit edilemedi.

Anahtar Kelimeler

• akut apendisit,hematolojik testler,laboratuar analiz,komplikasyonlar

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