Erişkin Hastalarda Akut Komplike Apandisit Tanısında Yeni Bir Belirteç: Nötrofil/Albümin Oranı

Year 2023, , 52 - 55, 30.09.2023

Serdar Sahin

https://doi.org/10.20492/aeahtd.1196719

Abstract

Amaç: Çalışmamız, akut apandisit (AA) ile akut komplike apandisit (ACA) arasında ayrım yapmada nötrofil/albümin oranının (NAR) etkinliğini araştırmayı ve ACA tanısında nötrofil/albümin oranının (NAR) en iyi kesme noktasını bulmayı amaçlamaktadır.
Materyal ve metod: Araştırmacı, bu çalışmayı apendektomi geçirmiş yetişkin 453 hastanın verilerini kullanarak gerçekleştirdi. Demografik veriler, preoperatif beyaz küre sayısı (WBC), nötrofil lenfosit oranı (NLR), nötrofil/albümin oranı (NAR), C-reaktif protein değeri (CRP) cerrahi sonuçları ve patolojik sonuçlar geriye dönük olarak değerlendirildi. Yazarlar hastaları AA ve ACA şeklinde iki gruba ayırmıştır.
Sonuçlar: Çalışmamızda AA grubu 362, ACA grubu 91 hastadan oluştu. WBC, NLR, CRP ve NAR, akut apandisit ile akut komplike apandisit ayrımında önemli parametrelerdi. Bu parametreler arasında NAR; AUROC duyarlılık ve özgüllük değerleri diğerlerinden daha güçlüydü. (AUROC: 0.963, duyarlılık: %95.6, özgüllük: %85.7). ROC eğrisi analizi sonucunda 2,79 mg/dl cut-off değeri bulundu.
Sonuç: NAR, ek zaman ve maliyet gerektirmeyen, rutin preoperatif kan sonuçlarıyla kolayca saptanan yeni bir inflamatuar belirteçtir. Nötrofil/albümin oranı (NAR), AA'yı ACA'dan ayırt etmek için hızlı, erişimi kolay ve güvenilir bir parametredir

Keywords

Apandisit, nötrofil/albümin oranı, tanı

A New Marker In The Diagnosis Of Acute Complicated Appendicitis In Adult Patients: Neutrophil/Albumin Ratio

Abstract

ABSTRACT
Aim: Our study aims to search the effectiveness of neutrophil/albumin ratio (NAR) in distinguishing between acute appendicitis (AA) and acute complicated appendicitis (ACA) and to find the best cut-off point of neutrophil/albumin ratio (NAR) for the diagnosis of ACA.
Material and method: This study was performed using data from 453 adult patient who underwent appendectomy and divided into two groups as AA and ACA. Demographic data, preoperative white blood cell count (WBC), neutrophil lymphocyte ratio (NLR), neutrophil/albumin ratio (NAR), C-reactive protein value (CRP) surgical outcomes, and pathological outcomes were retrospectively assessed for each groups.
Results: In our study, 362 patients were in the AA group and 91 patients were in the ACA group. WBC, NLR, CRP and NAR were significant parameters in differentiating acute appendicitis from acute complicated appendicitis. Among these parameters, NAR; AUROC sensitivity and specificity values were stronger than others. (AUROC: 0.963, sensitivity: 95.6%, specificity: 85.7%). As a result of the ROC curve analysis, a cut-off value of 2.79 mg/dl was found.
Conclusion: NAR is a novel inflammatory marker simply detected through routine preoperative blood results, with no additional time or cost. The neutrophil/albumin ratio (NAR) is a fast, easy to access and reliable parameter to differentiate AA from ACA.

Keywords

Appendicitis, neutrophil/albumin ratio, diagnosis

References

• 1. Debnath J, Kumar R, Mathur A, Sharma P, Kumar N, Shridhar N, et al. On the Role of Ultrasonography and CT Scan in the Diagnosis of Acute Appendicitis. Indian J Surg. 2015;77(Suppl 2):221-6.
• 2. Park JJ, Kim KA, Nam Y, Choi MH, Choi SY, Rhie J. Convolutional-neural-network-based diagnosis of appendicitis via CT scans in patients with acute abdominal pain presenting in the emergency department. Sci Rep. 2020;10(1):9556.
• 3. Lee JF, Leow CK, Lau WY. Appendicitis in the elderly. Aust N Z J Surg. 2000;70(8):593-6.
• 4. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-25.
• 5. 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(1):154-63.
• 6. Freund HR, Rubinstein E. Appendicitis in the aged. Is it really different? Am Surg. 1984;50(10):573-6.
• 7. Franz MG, Norman J, Fabri PJ. Increased morbidity of appendicitis with advancing age. Am Surg. 1995;61(1):40-4.
• 8. Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg. 2018;56:307-14.
• 9. Soldo I, Radisic Biljak V, Bakula B, Bakula M, Simundic AM. The diagnostic accuracy of clinical and laboratory parameters in the diagnosis of acute appendicitis in the adult emergency department population - a case control pilot study. Biochem Med (Zagreb). 2018;28(3):030712.
• 10. Ramasamy Ramu T, Chinnakkulam Kandhasamy S, Andappan A, Sankar TB. A Prospective Study on the Diagnostic Value of Hyperbilirubinemia as a Predictive Factor for Appendicular Perforation in Acute Appendicitis. Cureus. 2018;10(8):e3214.
• 11. Keohane D, O'Leary P, Nagle M, Cichelli K, McCormack T. A Correlation of Blood Panel Results and Histologically Confirmed Appendicitis. Cureus. 2020;12(9):e10641.
• 12. Goodman DA, Goodman CB, Monk JS. Use of the neutrophil:lymphocyte ratio in the diagnosis of appendicitis. Am Surg. 1995;61(3):257-9.
• 13. de Carvalho BR, Diogo-Filho A, Fernandes C, Barra CB. [Leukocyte count, C reactive protein, alpha-1 acid glycoprotein and erythrocyte sedimentation rate in acute appendicitis]. Arq Gastroenterol. 2003;40(1):25-30.
• 14. Kim HY, Park JH, Lee YJ, Lee SS, Jeon JJ, Lee KH. Systematic Review and Meta-Analysis of CT Features for Differentiating Complicated and Uncomplicated Appendicitis. Radiology. 2018;287(1):104-15.
• 15. Acarturk G, Acay A, Demir K, Ulu MS, Ahsen A, Yuksel S. Neutrophil-to-lymphocyte ratio in inflammatory bowel disease - as a new predictor of disease severity. Bratisl Lek Listy. 2015;116(4):213-7.
• 16. 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.
• 17. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(1):27.
• 18. Rafiq MS, Khan MM, Khan A, Ahmad B. Total leukocyte and neutrophil count as preventive tools in reducing negative appendectomies. Ulus Travma Acil Cerrahi Derg. 2015;21(2):102-6.
• 19. 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):177-81.
• 20. Walsh AJ, Bryant RV, Travis SP. Current best practice for disease activity assessment in IBD. Nat Rev Gastroenterol Hepatol. 2016;13(10):567-79. 21. Hou J, Feng W, Liu W, Hou J, Die X, Sun J, et al. The use of the ratio of C-reactive protein to albumin for the diagnosis of complicated appendicitis in children. Am J Emerg Med. 2022;52:148-54.
• 22. Kim M, Kim SJ, Cho HJ. International normalized ratio and serum C-reactive protein are feasible markers to predict complicated appendicitis. World J Emerg Surg. 2016;11:31.
• 23. Kim TH, Cho BS, Jung JH, Lee MS, Jang JH, Kim CN. Predictive Factors to Distinguish Between Patients With Noncomplicated Appendicitis and Those With Complicated Appendicitis. Ann Coloproctol. 2015;31(5):192-7.
• 24. Chojkier M. Inhibition of albumin synthesis in chronic diseases: molecular mechanisms. J Clin Gastroenterol. 2005;39(4 Suppl 2):S143-6.