Predicting High Risk Patients for Negative Appendectomy and Severe Appendicitis Using Inflammatory Biomarkers

Yıl 2022, Cilt: 17 Sayı: 2, 172 - 181, 15.07.2022

Alirıza Erdoğan , Selim Çınaroğlu

https://doi.org/10.17517/ksutfd.905255

Öz

Objective: The aim of the present study is to evaluate the value of inflammatory parameters and indices of complete blood count (CBC) and C-reactive protein (CRP) in predicting negative laparotomies and severity of acute appendicitis in adults.
Material and Methods: A total of 1389 patients who had undergone appendectomy between January 2015 and November 2020 were enrolled in this observational and cross-sectional study. Age, gender, preoperative CRP values, inflammatory parameters of CBC and the pathologic diagnosis were recorded.
Multivariate analysis and logistic regression analysis were performed.
Results: In multivariate model white blood cell (WBC), platelet count (PLT), mean platelet volume (MPV), absolute neutrophil and lymphocyte counts, neutrophil percentage (NEU%), lymphocyte percentage (LYM%), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio and CRP-to-lymphocyte
ratio (CLR) were significant discriminators of negative laparotomy (p<0.001; p=0.031; p=0.02; p<0.001; p<0.001; p<0.001; p<0.001; p<0.001; p=0.044 and p=0.012, respectively). Meanwhile age, CRP, plateletcrit, absolute neutrophil count, NEU%, NLR and CLR were significant predictors of severity (p=0.001; p<0.001; p=0.032; p=0.01; p=0.019; p=0.01 and p<0.001, respectively). These parameters were reanalyzed in the logistic regression equations. The OR of NLR was 1.737 (CI 1.275-2.366; p=0.001; 1-β err prob=0.993) for predicting negative laparotomy and the OR of CRP was 1.783 (CI 1.529-2.08; p<0.001; 1-β err prob=0.991) for predicting complicated cases.
Conclusion: Neutrophil-to-lymphocyte ratio is an easy and feasible marker to exclude patients without appendicitis whereas CRP is the most valuable predictive biomarker of complicated appendicitis.

Anahtar Kelimeler

Acute appendicitis, Complicated appendicitis, CRP, Negative laparotomy, Neutrophil-to-lymphocyte ratio

Enflamatuvar Biyobelirteçler Kullanılarak Negatif Apendektomi ve Şiddetli Apendisit İçin Riskli Hastaların Öngörülmesi

Öz

Amaç: Bu çalışmanın amacı yetişkinlerde akut apandisit nedeniyle yapılan apendektomilerde negatif laparotomiyi ve akut apandisitin şiddetini ön görmede tam kan sayımının (CBC), enflamatuvar biyo-belirteçlerin, bu parametreler kullanılarak hesaplanan indekslerin ve C-reaktif protein (CRP) seviyelerinin etkinliğinin değerlendirilmesidir.
Gereç ve Yöntemler: Bu kesitsel ve gözlemsel çalışmaya Ocak 2015 ile Kasım 2020 tarihleri arasında apendektomi geçirmiş 1389 hasta dâhil edilmiştir. Hastaların yaşı, cinsiyeti ve preoperatif kan tahlillerindeki CRP değerleri, CBC’ye ait enflamatuvar parametreleri ve patolojik tanıları kaydedilmiştir. Gruplar arasında çok değişkenli analizler ve lojistik regresyon analizleri yapılmıştır.
Bulgular: Çok değişkenli analiz sonucunda beyaz küre sayısı (WBC), trombosit sayısı (PLT), ortalama trombosit volümü (MPV), mutlak nötrofil ve lenfosit sayıları, nötrofil oranı (%NEU), lenfosit oranı (%LYM), nötrofil/lenfosit oranı (NLR), platelet/lenfosit oranı (PLR) ve CRP/lenfosit oranı (CLR) negatif laparotomiyi
anlamlı olarak predikte eden parametreler olarak belirlenmiştir (sırasıyla p<0.001; p=0.031; p=0.02; p<0.001; p<0.001; p<0.001; p<0.001; p<0.001; p=0.044 ve p=0.012). Aynı analizde yaş, CRP, plateletkrit, mutlak nötrofil sayısı, %NEU, NLR ve CLR ise akut apandisitin şiddetini anlamlı olarak öngören parametreler olarak belirlenmiştir (sırasıyla p=0.001; p<0.001; p=0.0,32; p=0.01; p=0.019; p=0.01 ve p<0.001). Bu parametrelerin lojistik regresyon denklemleri ile tekrar incelenmesi sonucunda NLR’nin negatif laparotomiyi öngörmedeki OR=1.737 (CI 1.275-2.366; p=0.001; 1-β err prob=0.993) ve CRP’nin komplike vakaları öngörmedeki OR= 1.783 (CI 1.529-2.08; p<0.001; 1-β err prob= 0.991) olarak hesaplanmıştır.
Sonuç: NLR, akut apandisiti olmayan vakaların tespitinde kolay ve pratikte uygulanabilir bir belirteçtir. CRP ise komplike akut apandisiti öngörmede en kıymetli biyobelirteçtir.

Anahtar Kelimeler

Akut apandisit, Komplike apandisit, Nötrofil/lenfosit oranı, CRP, Negatif laparotomi

Kaynakça

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