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

Year 2022, Volume: 17 Issue: 2, 172 - 181, 15.07.2022
https://doi.org/10.17517/ksutfd.905255

Abstract

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.

References

  • 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 Apr;15(1):27.
  • Özozan ÖV, Vural V. High C-reactive protein level as a predictor for appendiceal perforation. Ulus Travma ve Acil Cerrahi Derg. 2020 Jan;26(1):63–66.
  • Çetin H, Ekici MF, Yıldırım AC, Zeren S, Yaylak F AM. İliopsoas apsesi ile prezente olan retroçekal perfore apandisit: Vaka sunumu. KSÜ Tıp Fak Der 2021;16(1): 138-141
  • Samir M, Hefzy M, Gaber M, Moghazy K. Added value of graded compression ultrasound to the Alvarado score in cases of right iliac fossa pain. African J Emerg Med. 2016;6(3):138–143.
  • Sasaki Y, Komatsu F, Kashima N, Suzuki T, Takemoto I, Kijima S et al. Clinical prediction of complicated appendicitis: A case- control study utilizing logistic regression. World J Clin cases. 2020 Jun;8(11):2127–2136.
  • Bozan MB, Yazar FM, Güler Ö, Azak Bozan A, Boran ÖF. Preoperative immature granulocyte count and percentage for complicated acute appendicitis and uncomplicated acute appendicitis (A retrospective cohort study). Med Sci. 2021;25(110):760–766.
  • Chandel V, Batt SH, Bhat MY, Kawoosa NU, Yousuf A, Zargar BR. Procalcitonin as the Biomarker of Inflammation in Diagnosis of Appendicitis in Pediatric Patients and Prevention of Unnecessary Appendectomies. Indian J Surg. 2011;73(2):136–141.
  • Kostakis ID, Machairas N, Damaskos C, Doula C, Tsaparas P, Charalampoudis P et al. Platelet indices and neutrophil to lymphocyte ratio in adults with acute appendicitis. South African J Surg. 2016;54(1):29–34.
  • STROBE statement- Checklist of items that should be included in reports of observational studies (© STROBE Initiative). (2008). International Journal of Public Health. Birkhauser Verlag Basel.
  • Erdfelder E, FAul F, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149–1160.
  • Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–191.
  • Wang B, Wu P, Kwan B, Tu XM, Feng C. Simpson’s Paradox: Examples. Shanghai Arch Psychiatry. 2018;30(2):139–143.
  • Whitworth CM, Whitworth PW, Sanfillipo J, Polk HC. Values of diagnostic laparoscopy in young women with possible appendicitis. Surg Gynecol Obstet. 1988;167(3):187–90.
  • 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 Feb;80(1):61-67.
  • Koyuncu S, İsmail O. The role of C-reactive protein to lymphocyte ratio in the differentiation of acute and perforated appendicitis. Ulus Travma ve Acil Cerrahi Derg. 2020 Sep;26(5):760–764.
  • Goodman DA, Goodman CB, Monk JS. Use of the neutrophil: lymphocyte ratio in the diagnosis of appendicitis. Am Surg. 1995;61(3):257–259.
  • Boshnak N, Boshnaq M, Elgohary H. Evaluation of Platelet Indices and Red Cell Distribution Width as New Biomarkers for the Diagnosis of Acute Appendicitis. J Investig Surg. 2018 Mar;31(2):121–9.
  • 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 Jan;219(1):154-163.
  • Daldal E, Dagmura H. The Correlation between complete blood count parameters and appendix diameter for the diagnosis of acute appendicitis. healthcare. 2020 Feb;8(1):39.
  • Ahmad KA, Ideris N, Abd Aziz SHS. A cross-sectional study of neutrophil to- lymphocyte ratio in diagnosing acute appendicitis in hospital Melaka. Malaysian J Med Sci. 2019;26(6):55–66.
  • Khan A, Riaz M, Kelly ME, Khan W, Waldron R, Barry K et al. Prospective validation of neutrophil-to-lymphocyte ratio as a diagnostic and management adjunct in acute appendicitis. Ir J Med Sci. 2018 May;187(2):379–384.
  • Kim CH, Kim SJ, Lee MJ, Kwon YE, Kim YL, Park KS et al. An increase in mean platelet volume from baseline is associated with mortality in patients with severe sepsis or septic shock. PLoS One. 2015;10(3) :e0119437.
  • Yardımcı S, Uğurlu MÜ, Coşkun M, Attaallah W, Yeğen ŞC. Nötrofil- lenfosit oranı ve ortalama trombosit hacminin akut apandisitin şiddetini belirlemedeki rolü. Ulus Travma ve Acil Cerrahi Derg. 2016;22(2):163–168.
  • Fan Z, Zhang Y, Pan J, Wang S. Acute appendicitis and mean platelet volume: A systemic review and meta-analysis. Ann Clin Lab Sci. 2017;47(6):768–772.
  • Pehlivanlı F, Aydin O. Role of platelet to lymphocyte ratio as a biomedical marker for the pre-operative diagnosis of acute appendicitis. Surg Infect (Larchmt). 2019 Dec;20(8):631-636.
  • Liu L, Shao Z, Yu H, Zhang W, Wang H, Mei Z. Is the platelet to lymphocyte ratio a promising biomarker to distinguish acute appendicitis? Evidence from a systematic review with meta-analysis. PLoS One. 2020 May;15(5):5.
  • Farahbakhsh F, Torabi M, Mirzaee M. A comparative study on the diagnostic validity of three scoring systems in the diagnosis of acute appendicitis in emergency centres. African J Emerg Med. 2020;10(3):132–135.
  • Sharma P, Hegde R, Kulkarni A, Soin P, Kochar P, Rotem E. Imaging right lower quadrant pain: Not always appendicitis. Clin Imaging. 2020 Jul;63:65–82.
  • Shimoda M, Maruyama T, Nishida K, Suzuki K, Tago T, Shimazaki J et al. Preoperative high C-reactive protein level is associated with an increased likelihood for conversion from laparoscopic to open appendectomy in patients with acute appendicitis. Clin Exp Gastroenterol. 2019;12:141–147.
  • Withers AS, Grieve A, Loveland JA. Correlation of white cell count and CRP in acute appendicitis in paediatric patients. South African J Surg. 2019;57(4):9–13.
  • Andersson REB. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004 Jan;91(1):28–37.
  • Koyuncu S, İsmail O. The role of C-reactive protein to lymphocyte ratio in the differentiation of acute and perforated appendicitis. Ulus Travma Acil Cerrahi Derg. 2020;26(5):760764.

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

Year 2022, Volume: 17 Issue: 2, 172 - 181, 15.07.2022
https://doi.org/10.17517/ksutfd.905255

Abstract

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.

References

  • 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 Apr;15(1):27.
  • Özozan ÖV, Vural V. High C-reactive protein level as a predictor for appendiceal perforation. Ulus Travma ve Acil Cerrahi Derg. 2020 Jan;26(1):63–66.
  • Çetin H, Ekici MF, Yıldırım AC, Zeren S, Yaylak F AM. İliopsoas apsesi ile prezente olan retroçekal perfore apandisit: Vaka sunumu. KSÜ Tıp Fak Der 2021;16(1): 138-141
  • Samir M, Hefzy M, Gaber M, Moghazy K. Added value of graded compression ultrasound to the Alvarado score in cases of right iliac fossa pain. African J Emerg Med. 2016;6(3):138–143.
  • Sasaki Y, Komatsu F, Kashima N, Suzuki T, Takemoto I, Kijima S et al. Clinical prediction of complicated appendicitis: A case- control study utilizing logistic regression. World J Clin cases. 2020 Jun;8(11):2127–2136.
  • Bozan MB, Yazar FM, Güler Ö, Azak Bozan A, Boran ÖF. Preoperative immature granulocyte count and percentage for complicated acute appendicitis and uncomplicated acute appendicitis (A retrospective cohort study). Med Sci. 2021;25(110):760–766.
  • Chandel V, Batt SH, Bhat MY, Kawoosa NU, Yousuf A, Zargar BR. Procalcitonin as the Biomarker of Inflammation in Diagnosis of Appendicitis in Pediatric Patients and Prevention of Unnecessary Appendectomies. Indian J Surg. 2011;73(2):136–141.
  • Kostakis ID, Machairas N, Damaskos C, Doula C, Tsaparas P, Charalampoudis P et al. Platelet indices and neutrophil to lymphocyte ratio in adults with acute appendicitis. South African J Surg. 2016;54(1):29–34.
  • STROBE statement- Checklist of items that should be included in reports of observational studies (© STROBE Initiative). (2008). International Journal of Public Health. Birkhauser Verlag Basel.
  • Erdfelder E, FAul F, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149–1160.
  • Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–191.
  • Wang B, Wu P, Kwan B, Tu XM, Feng C. Simpson’s Paradox: Examples. Shanghai Arch Psychiatry. 2018;30(2):139–143.
  • Whitworth CM, Whitworth PW, Sanfillipo J, Polk HC. Values of diagnostic laparoscopy in young women with possible appendicitis. Surg Gynecol Obstet. 1988;167(3):187–90.
  • 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 Feb;80(1):61-67.
  • Koyuncu S, İsmail O. The role of C-reactive protein to lymphocyte ratio in the differentiation of acute and perforated appendicitis. Ulus Travma ve Acil Cerrahi Derg. 2020 Sep;26(5):760–764.
  • Goodman DA, Goodman CB, Monk JS. Use of the neutrophil: lymphocyte ratio in the diagnosis of appendicitis. Am Surg. 1995;61(3):257–259.
  • Boshnak N, Boshnaq M, Elgohary H. Evaluation of Platelet Indices and Red Cell Distribution Width as New Biomarkers for the Diagnosis of Acute Appendicitis. J Investig Surg. 2018 Mar;31(2):121–9.
  • 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 Jan;219(1):154-163.
  • Daldal E, Dagmura H. The Correlation between complete blood count parameters and appendix diameter for the diagnosis of acute appendicitis. healthcare. 2020 Feb;8(1):39.
  • Ahmad KA, Ideris N, Abd Aziz SHS. A cross-sectional study of neutrophil to- lymphocyte ratio in diagnosing acute appendicitis in hospital Melaka. Malaysian J Med Sci. 2019;26(6):55–66.
  • Khan A, Riaz M, Kelly ME, Khan W, Waldron R, Barry K et al. Prospective validation of neutrophil-to-lymphocyte ratio as a diagnostic and management adjunct in acute appendicitis. Ir J Med Sci. 2018 May;187(2):379–384.
  • Kim CH, Kim SJ, Lee MJ, Kwon YE, Kim YL, Park KS et al. An increase in mean platelet volume from baseline is associated with mortality in patients with severe sepsis or septic shock. PLoS One. 2015;10(3) :e0119437.
  • Yardımcı S, Uğurlu MÜ, Coşkun M, Attaallah W, Yeğen ŞC. Nötrofil- lenfosit oranı ve ortalama trombosit hacminin akut apandisitin şiddetini belirlemedeki rolü. Ulus Travma ve Acil Cerrahi Derg. 2016;22(2):163–168.
  • Fan Z, Zhang Y, Pan J, Wang S. Acute appendicitis and mean platelet volume: A systemic review and meta-analysis. Ann Clin Lab Sci. 2017;47(6):768–772.
  • Pehlivanlı F, Aydin O. Role of platelet to lymphocyte ratio as a biomedical marker for the pre-operative diagnosis of acute appendicitis. Surg Infect (Larchmt). 2019 Dec;20(8):631-636.
  • Liu L, Shao Z, Yu H, Zhang W, Wang H, Mei Z. Is the platelet to lymphocyte ratio a promising biomarker to distinguish acute appendicitis? Evidence from a systematic review with meta-analysis. PLoS One. 2020 May;15(5):5.
  • Farahbakhsh F, Torabi M, Mirzaee M. A comparative study on the diagnostic validity of three scoring systems in the diagnosis of acute appendicitis in emergency centres. African J Emerg Med. 2020;10(3):132–135.
  • Sharma P, Hegde R, Kulkarni A, Soin P, Kochar P, Rotem E. Imaging right lower quadrant pain: Not always appendicitis. Clin Imaging. 2020 Jul;63:65–82.
  • Shimoda M, Maruyama T, Nishida K, Suzuki K, Tago T, Shimazaki J et al. Preoperative high C-reactive protein level is associated with an increased likelihood for conversion from laparoscopic to open appendectomy in patients with acute appendicitis. Clin Exp Gastroenterol. 2019;12:141–147.
  • Withers AS, Grieve A, Loveland JA. Correlation of white cell count and CRP in acute appendicitis in paediatric patients. South African J Surg. 2019;57(4):9–13.
  • Andersson REB. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004 Jan;91(1):28–37.
  • Koyuncu S, İsmail O. The role of C-reactive protein to lymphocyte ratio in the differentiation of acute and perforated appendicitis. Ulus Travma Acil Cerrahi Derg. 2020;26(5):760764.
There are 32 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Araştırma Makaleleri
Authors

Alirıza Erdoğan 0000-0002-8931-0907

Selim Çınaroğlu 0000-0002-4495-6106

Early Pub Date July 11, 2022
Publication Date July 15, 2022
Submission Date March 29, 2021
Acceptance Date April 29, 2021
Published in Issue Year 2022 Volume: 17 Issue: 2

Cite

AMA Erdoğan A, Çınaroğlu S. Predicting High Risk Patients for Negative Appendectomy and Severe Appendicitis Using Inflammatory Biomarkers. KSU Medical Journal. July 2022;17(2):172-181. doi:10.17517/ksutfd.905255