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The Clinical Significance of Shock Index and GFR in the Differential Diagnosis of Perforated Appendicitis

Yıl 2022, Cilt 12, Sayı 4, 504 - 508, 31.07.2022
https://doi.org/10.16899/jcm.1090115

Öz

Aim: The aim of the study is to investigate whether the shock index (SI) and glomerular filtration rate (GFR) have significance in differentiating acute appendicitis from complicated perforated acute appendicitis. Materials-Methods: Patients were searched retrospectively on the hospital database. Age, gender, C-reactive protein (CRP), leukocyte (WBC), total bilirubin (T.BIL), urea, creatinine, pulse (NBZ), and arterial blood pressure (TA) values of the patients were searched retrospectively on the hospital database and a database was created by using these patient variables. GFR and SI were calculated by using these data. The surgical notes about patients were reviewed retrospectively, and they were divided into two groups, namely perforated appendicitis and non-perforated appendicitis. The data were analyzed to investigate whether GFR and SI were effective in predicting perforation. Results: It was observed that NB/TA value had more frequent pathological findings in patients with perforated appendicitis (p<0.001). It was found that age (p=0.001), CRP (p<0.001), WBC (p<0.001), T. BIL (p=0.002), NB (p=0.017), and NB/TA (p<0.001) values of the patients in the perforated appendicitis group were higher than those of the patients in the normal appendicitis group, while GFR (p<0.001) and TA (p<0.001) values were lower (p<0.05). Conclusion: It is thought that SI and GFR may be a prognostic parameter for showing both perforation and the associated increased mortality rate.

Kaynakça

  • 1. Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Annals of translational medicine (2016); 4(19).
  • 2. G.M. Doherty (Ed.), Current Diagnosis and Treatment (third ed.), McGraw Hill, New York, NY (2010), pp. 615-620
  • 3. Liu W, Wei Qiang J & Xun Sun R. Comparison of multislice computed tomography and clinical scores for diagnosing acute appendicitis. Journal of International Medical Research (2015); 43(3), 341-349.
  • 4. McKay R, & Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. The American journal of emergency medicine (2007); 25(5), 489-493.
  • 5. H Kariman, M Shojaee, A Sabzghabaei, R Khatamian, H Derakhshanfar, H Hatamabdi. Evaluation of the Alvarado score in acute abdominal pain. Ulus Travma Acil Cerrahi Derg, 20 (2014); pp. 86-90
  • 6. Flum DR. Acute appendicitis—appendectomy or the “antibiotics first” strategy. New England Journal of Medicine (2015); 372(20), 1937-1943.
  • 7. S Muller, C Falch, S Axt, et al. Diagnostic accuracy of hyperbilirubinaemia in anticipating appendicitis and its severity. Emerg Med J, 32 (2015); pp. 698-702
  • 8. Shin DH, Cho YS, Kim YS, Ahn HC, Oh YT, Park SO et al. Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly. Journal of Clinical Laboratory Analysis (2018); 32(1), e22177
  • 9. Kim H, Kim Y, Kim KH, Yeo CD, Kim JW, & Lee, H. K. Use of delta neutrophil index for differentiating low-grade community-acquired pneumonia from upper respiratory infection. Annals of laboratory medicine(2015); 35(6), 647-650.
  • 10. Myint PK, Sheng S, Xian Y, Matsouaka R, Reeves M, Saver JL. Shock index predicts patient-related clinical outcomes in stroke. J. Am. Heart Assoc. 2018; 7, 1–12.
  • 11. Shin R, Lee SM, Sohn B, Lee DW, Song I, Chai YJ et al. Predictors of morbidity and mortality after surgery for intestinal perforation. Annals of coloproctology (2016); 32(6), 221.
  • 12. Msolli MA, Beltaief K, Bouida W, et al. Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis. BMC emergency medicine 2018;18(1):15 pmid:29793425
  • 13. Dayawansa NH, Segan JD, Yao HH, et al. Incidence of normal white cell count and C‐reactive protein in adults with acute appendicitis. ANZ journal of surgery 2018;88(6):E539–E43 pmid:27625212
  • 14. Horn CB, Tian D, Bochicchio GV & Turnbull IR. Incidence, demographics, and outcomes of nonoperative management of appendicitis in the United States. journal of surgical research (2018); 223, 251-258.
  • 15. Li Y, Mi C, Li W & She J. Diagnosis of acute appendicitis by endoscopic retrograde appendicitis therapy (ERAT): combination of colonoscopy and endoscopic retrograde appendicography. Digestive diseases and sciences (2016); 61(11), 3285-3291.
  • 16. SY Guraya, TA Al-Tuwaijri, GA Khairy, KR Murshid. Validity of leukocyte count to predict the severity of acute appendicitis. Saudi Med J, 26 (2005), pp. 1945-1947
  • 17. HL Adams, SS Jaunoo. Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation. Eur J Trauma Emerg Surg, 42 (2016), pp. 249-252
  • 18. Olaussen A, Blackburn T, Mitra B, Fitzgerald M. Review article: Shock Index for prediction of critical bleeding post-trauma: A systematic review. Emerg. Med. Australas 2014; 26, 223–228
  • 19. Toosi MS, Merlino JD, & Leeper KV. Prognostic value of the shock index along with transthoracic echocardiography in risk stratification of patients with acute pulmonary embolism. The American journal of cardiology (2008); 101(5), 700-705.
  • 20. Chung JY, Hsu CC, Chen JH, Chen WL, Lin HJ, Guo HR et al. Shock index predicted mortality in geriatric patients with influenza in the emergency department. The American Journal of Emergency Medicine (2019); 37(3), 391-394.
  • 21. Jouffroy R, Tourtier JP, Gueye P, Bloch-Laine E, Bounes V, Debaty G et al. Prehospital shock index to assess 28-day mortality for septic shock. The American Journal of Emergency Medicine (2020); 38(7), 1352-1356.
  • 22. Doğanay F, Elkonca F, Seyhan AU, Yılmaz E, Batırel A & Ak R. Shock index as a predictor of mortality among the Covid-19 patients. The American journal of emergency medicine (2021); 40, 106-109.
  • 23. Rule AD, & Glassock RJ. GFR estimating equations: getting closer to the truth?. Clinical Journal of the American Society of Nephrology(2013); 8(8), 1414-1420.
  • 24. Yoshioka T, Nishida T, Tsujii M, Kato M, Hayashi Y, Komori M et al. Renal dysfunction is an independent risk factor for bleeding after gastric ESD. Endoscopy International Open (2015); 3(01), E39-E45.
  • 25. Sasaki Y, Komatsu F, Kashima N, Suzuki T, Takemoto I, Kijima, et al. Clinical prediction of complicated appendicitis: A case-control study utilizing logistic regression. World Journal of Clinical Cases (2020); 8(11), 2127.

Şok İndeksi ve GFR’nin Perfore Apandisit Ayırıcı Tanısındaki Klinik Önemi

Yıl 2022, Cilt 12, Sayı 4, 504 - 508, 31.07.2022
https://doi.org/10.16899/jcm.1090115

Öz

Amaç: Çalışmanın amacı akut apandisit ile komplike olmuş perfore akut apandisit ayırımında şok indeksinin (SI) ve glomerüler filtrasyon hızı (GFR)’nin öneminin olup olmadığı araştırılmasıdır. Gereç-Yötem: Hastalar hastane veri tabanı kullanılarak retrospektif olarak taranmıştır. Hastaların yaş, cinsiyet, C-reaktif protein (CRP), lökosit (WBC), total bilirubin (T.BİL), üre, kreatinin, nabız (NBZ), arteryal tansiyon (TA) değerleri hastane kayıt sisteminden geriye dönük taranmış ve veri tabanı oluşturulmuştur. Bu veriler kullanılarak GFR ve SI hesaplanmıştır. Hastaların ameliyat notları retrospektif olarak incelenmiş ve hastalar perfore apandisit ve perfore olmayan apandisit olarak iki gruba ayrılmıştır. Veriler analiz edilerek GFR ve SI’nin perforasyonu öngörmede etkili olup olmadığı araştırılmıştır. Bulgular: Perfore apandisit hastalarında NB/TA değerinin daha sık patolojik bulguya sahip olduğu gözlenmiştir (p<0,001). Perfore apandisit grubunda yer alan hastaların Yaş (p=0,001), CRP (p<0,001), WBC (p<0,001), T. BİL (p=0,002), NB (p=0,017) ve NB/TA (p<0,001) değerlerinin normal apandisit grubunda yer alan hastalara göre daha yüksek; GFR (p<0,001) ve TA (p<0,001) değerlerinin ise normal apandisit grubunda yer alan hastalara göre daha düşük olduğu gözlenmiştir (p<0,05). Sonuç: SI’nin ve GFR’nin hem perforasyonu hem de buna bağlı artan mortalite oranını göstermede prognostik bir parametre olabileceği düşünülmektedir.

Kaynakça

  • 1. Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Annals of translational medicine (2016); 4(19).
  • 2. G.M. Doherty (Ed.), Current Diagnosis and Treatment (third ed.), McGraw Hill, New York, NY (2010), pp. 615-620
  • 3. Liu W, Wei Qiang J & Xun Sun R. Comparison of multislice computed tomography and clinical scores for diagnosing acute appendicitis. Journal of International Medical Research (2015); 43(3), 341-349.
  • 4. McKay R, & Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. The American journal of emergency medicine (2007); 25(5), 489-493.
  • 5. H Kariman, M Shojaee, A Sabzghabaei, R Khatamian, H Derakhshanfar, H Hatamabdi. Evaluation of the Alvarado score in acute abdominal pain. Ulus Travma Acil Cerrahi Derg, 20 (2014); pp. 86-90
  • 6. Flum DR. Acute appendicitis—appendectomy or the “antibiotics first” strategy. New England Journal of Medicine (2015); 372(20), 1937-1943.
  • 7. S Muller, C Falch, S Axt, et al. Diagnostic accuracy of hyperbilirubinaemia in anticipating appendicitis and its severity. Emerg Med J, 32 (2015); pp. 698-702
  • 8. Shin DH, Cho YS, Kim YS, Ahn HC, Oh YT, Park SO et al. Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly. Journal of Clinical Laboratory Analysis (2018); 32(1), e22177
  • 9. Kim H, Kim Y, Kim KH, Yeo CD, Kim JW, & Lee, H. K. Use of delta neutrophil index for differentiating low-grade community-acquired pneumonia from upper respiratory infection. Annals of laboratory medicine(2015); 35(6), 647-650.
  • 10. Myint PK, Sheng S, Xian Y, Matsouaka R, Reeves M, Saver JL. Shock index predicts patient-related clinical outcomes in stroke. J. Am. Heart Assoc. 2018; 7, 1–12.
  • 11. Shin R, Lee SM, Sohn B, Lee DW, Song I, Chai YJ et al. Predictors of morbidity and mortality after surgery for intestinal perforation. Annals of coloproctology (2016); 32(6), 221.
  • 12. Msolli MA, Beltaief K, Bouida W, et al. Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis. BMC emergency medicine 2018;18(1):15 pmid:29793425
  • 13. Dayawansa NH, Segan JD, Yao HH, et al. Incidence of normal white cell count and C‐reactive protein in adults with acute appendicitis. ANZ journal of surgery 2018;88(6):E539–E43 pmid:27625212
  • 14. Horn CB, Tian D, Bochicchio GV & Turnbull IR. Incidence, demographics, and outcomes of nonoperative management of appendicitis in the United States. journal of surgical research (2018); 223, 251-258.
  • 15. Li Y, Mi C, Li W & She J. Diagnosis of acute appendicitis by endoscopic retrograde appendicitis therapy (ERAT): combination of colonoscopy and endoscopic retrograde appendicography. Digestive diseases and sciences (2016); 61(11), 3285-3291.
  • 16. SY Guraya, TA Al-Tuwaijri, GA Khairy, KR Murshid. Validity of leukocyte count to predict the severity of acute appendicitis. Saudi Med J, 26 (2005), pp. 1945-1947
  • 17. HL Adams, SS Jaunoo. Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation. Eur J Trauma Emerg Surg, 42 (2016), pp. 249-252
  • 18. Olaussen A, Blackburn T, Mitra B, Fitzgerald M. Review article: Shock Index for prediction of critical bleeding post-trauma: A systematic review. Emerg. Med. Australas 2014; 26, 223–228
  • 19. Toosi MS, Merlino JD, & Leeper KV. Prognostic value of the shock index along with transthoracic echocardiography in risk stratification of patients with acute pulmonary embolism. The American journal of cardiology (2008); 101(5), 700-705.
  • 20. Chung JY, Hsu CC, Chen JH, Chen WL, Lin HJ, Guo HR et al. Shock index predicted mortality in geriatric patients with influenza in the emergency department. The American Journal of Emergency Medicine (2019); 37(3), 391-394.
  • 21. Jouffroy R, Tourtier JP, Gueye P, Bloch-Laine E, Bounes V, Debaty G et al. Prehospital shock index to assess 28-day mortality for septic shock. The American Journal of Emergency Medicine (2020); 38(7), 1352-1356.
  • 22. Doğanay F, Elkonca F, Seyhan AU, Yılmaz E, Batırel A & Ak R. Shock index as a predictor of mortality among the Covid-19 patients. The American journal of emergency medicine (2021); 40, 106-109.
  • 23. Rule AD, & Glassock RJ. GFR estimating equations: getting closer to the truth?. Clinical Journal of the American Society of Nephrology(2013); 8(8), 1414-1420.
  • 24. Yoshioka T, Nishida T, Tsujii M, Kato M, Hayashi Y, Komori M et al. Renal dysfunction is an independent risk factor for bleeding after gastric ESD. Endoscopy International Open (2015); 3(01), E39-E45.
  • 25. Sasaki Y, Komatsu F, Kashima N, Suzuki T, Takemoto I, Kijima, et al. Clinical prediction of complicated appendicitis: A case-control study utilizing logistic regression. World Journal of Clinical Cases (2020); 8(11), 2127.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Orjinal Araştırma
Yazarlar

Ferhat ÇAY> (Sorumlu Yazar)
BALIKESİR ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0001-5323-1599
Türkiye


Ali DURAN>
balıkesir üniversitesi tıp fakültesi
0000-0002-2567-5317
Türkiye

Destekleyen Kurum yok
Proje Numarası yok
Erken Görünüm Tarihi 1 Haziran 2022
Yayımlanma Tarihi 31 Temmuz 2022
Kabul Tarihi 18 Nisan 2022
Yayınlandığı Sayı Yıl 2022, Cilt 12, Sayı 4

Kaynak Göster

AMA Çay F. , Duran A. The Clinical Significance of Shock Index and GFR in the Differential Diagnosis of Perforated Appendicitis. J Contemp Med. 2022; 12(4): 504-508.