KOMPLİKASYONLU AKUT APANDİSİTİ TAHMİN ETMEDE İNFLAMATUVAR PARAMETRELERİN VE SKORLAMA SİSTEMLERİNİN ROLÜ

Year 2024, Volume: 25 Issue: 3, 305 - 316, 30.09.2024

Mehmet Gökhan Kaya , Ethem Acar

https://doi.org/10.69601/meandrosmdj.1528717

Abstract

Amaç: Akut apandisit tanısı alan hastaların rutin parametrelerini değerlendirilerek, hastaların komplikasyon durumunu ve bu parametrelerin hastalığın ciddiyeti üzerindeki etkilerini tespit etmeyi amaçlanmıştır.
Gereç ve Yöntem: Bu çalışma, acil serviste (AS) 1 Ocak 2019 ve 31 Aralık 2020 tarihleri arasında akut apandisit (AA) tanısı alan hastaların araştırıldığı retrospektif bir çalışmadır. Hastaların demografik verileri, kan tetkikleri, AS’de hesaplanan skorları kayıt altına alınmıştır.
Bulgular: Çalışmaya dâhil edilen 223 hastanın %63,7’si erkek olup yaş ortalaması 37.5 ± 16.8 yıl olarak hesaplanmıştır. Komplike apandisit (KA) olgularının hematolojik parametreler açısından istatistiksel olarak anlamlı düzeyde daha yüksek nötrofil / lenfosit oranı (NLR), platelet / lenfosit oranı (PLR), C-reaktif protein (CRP), sistemik immun inflamasyon indeksi (SII), beyaz kan hücresi (WBC), nötrofil düzeylerine sahip olduğu bulunmuş; buna karşın lenfosit / C-reaktif protein oranı (LCRP) ve lenfosit düşüklüğü tespit edilmiştir. Ayrıca KA olgularının istatistiksel olarak anlamlı düzeyde daha yüksek Apandisit İnflamatuar Yanıt (AIR) ve Alvarado skorlarına sahip oldukları tespit edilmiştir. KA tespit etmede AIR ve Alvarado skorları, LCRP ve NLR paramatrelerinin sensivite ve spesifiteleri incelendiğinde; AIR skoru için sırasıyla %85,9, %47,9 (kesme ≥6, %95 CI, 0.675-0.821, AUC: 0.748; p<0,01), Alvarado skoru için sırasıyla %80,6, %44,5 (kesme ≥6, %95 Cl, 0,527-0,683, AUC 0,605; p:0,10), olarak bulunmuştur.
Sonuç: İnflamatuvar belirteçlerin, KA / Non- komplike apandisit (NKA) ayrımında önemli parametreler olduğu tespit edilmiştir. Çalışmada; LCRP, SII, NLR, PLR gibi değerlerin, KA / NKA ayrımında kullanışlı parametreler olarak bulunmuştur.

Keywords

Akut apandisit, Apandisit inflamatuvar yanıt skoru, Alvarado skoru, Acil servis, Komplike apandisit, Non-komplike apandisit

THE ROLE OF INFLAMMATORY PARAMETERS AND SCORING SYSTEMS IN PREDICTING COMPLICATED ACUTE APPENDICITIS

Abstract

Aim: To assess the complications associated with acute appendicitis (AA) and to evaluate how specific routine patient parameters influence disease severity.
Materials and Methods: A retrospective study was carried out on patients diagnosed with AA who presented to the emergency department (ED) between January 1, 2019, and December 31, 2020. Data collected included demographic details, blood test results, and specific scoring systems utilized in the ED.
Results: Of the 223 patients studied, 63.7% were male with a mean age of 37.5 ± 16.8 years. Patients with complicated appendicitis (CA) showed significantly elevated hematological parameters such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), systemic immune inflammation index (SII), white blood cell count (WBC), and neutrophil levels. Conversely, decreased lymphocyte/C-reactive protein ratio (LCRP) and lymphocyte levels were noted. Furthermore, CA cases exhibited significantly greater Appendicitis Inflammatory Response (AIR) and Alvarado scores. In the context of diagnosing CA, the AIR score had a sensitivity of 85.9% and a specificity of 47.9% with a cut-off value of ≥6 (95% CI 0.675-0.821, Area Under the Curve (AUC): 0.748; p<0.01). The Alvarado score showed a sensitivity of 80.6% and a specificity of 44.5%, using a cut-off value of ≥6 (95% CI 0.527-0.683, AUC: 0.605; p=0.10).
Conclusion: Our study determined that inflammatory markers such as LCRP, SII, NLR, and PLR serve as significant indicators for distinguishing between CA and its NCA.

Keywords

Acute appendicitis, Appendicitis inflammatory response score, Alvarado score, Emergency department, Complicated appendicitis, Non-complicated appendicitis

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