The diagnostic value of systemic inflammation indices in pregnant women with acute appendicitis and their relationship with the duration of hospital stay

Öz

Aim: Physiological and anatomical changes occurring during pregnancy can complicate the diagnosis of acute appendicitis (AA). This study aimed to evaluate the diagnostic performance of systemic inflammation indices in distinguishing AA in pregnant women and to assess their relationship with hospital stay duration. Material and Methods: This retrospective study encompassed 32 pregnant patients who underwent appendectomy and 32 healthy pregnant (control group). Systemic inflammation indices were calculated based on neutrophil (N), platelet (P), and lymphocyte (L) levels as follows: The neutrophil-to-lymphocyte ratio (NLR) = N/L; the platelet-to-lymphocyte ratio (PLR) = P/L; systemic immune-inflammation index (SII) = (N×P)/L. Results: The AA group had higher median levels of PLR (30.9 vs. 22.4, p = 0.035), NLR (6.1 vs. 3.5, p < 0.001), and SII (1370 vs. 807, p < 0.001) compared to the control group. Systemic inflammation indices showed a positive correlation with the Alvarado score and the length of hospital stay. SII values demonstrated superior diagnostic performance in predicting AA compared to NLR and PLR values. The threshold value for SII in predicting AA was identified as >1316, with a sensitivity of 85.8% and a specificity of 72.5%. Conclusions: Systemic inflammation indices, particularly SII, demonstrate strong diagnostic value in distinguishing AA in pregnant women. SII demonstrated superior accuracy over NLR and PLR, correlating with both the Alvarado score and hospital stay, suggesting its utility as a diagnostic and prognostic marker.

Anahtar Kelimeler

• acute appendicitis
• Alvarado score
• pregnancy
• systemic inflammation indices
• systemic immune-inflammation index

Gebe kadınlarda akut apandisitli hastalarda sistemik inflamasyon indekslerinin tanısal değeri ve hastanede kalış süresi ile korelasyonu

Öz

Amaç: Gebelik sırasında meydana gelen fizyolojik ve anatomik değişiklikler, akut apandisit (AA) tanısını zorlaştırabilir. Bu çalışmada gebe kadınlarda AA'yı ayırt etmede sistemik inflamasyon indekslerinin tanısal performansının değerlendirilmesi ve hastanede kalış süresi ile ilişkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu retrospektif çalışma, apendektomi uygulanan 32 gebe hasta ile 32 sağlıklı gebe (kontrol grubu) üzerinde gerçekleştirilmiştir. Sistemik inflamasyon indeksleri, nötrofil (N), trombosit (P) ve lenfosit (L) düzeylerine göre şu şekilde hesaplanmıştır: nötrofil-lenfosit oranı (NLR) = N/L; trombosit-lenfosit oranı (PLR) = P/L; sistemik immün-inflamasyon indeksi (SII) = (N×P)/L. Bulgular: AA grubunda kontrol grubuna kıyasla PLR (30.9 vs. 22.4, p = 0.035), NLR (6.1 vs. 3.5, p < 0.001) ve SII (1370 vs. 807, p < 0.001) değerleri daha yüksek bulunmuştur. Sistemik inflamasyon indeksleri, Alvarado skoru ve hastanede kalış süresi ile pozitif korelasyon göstermiştir. SII, NLR ve PLR'ye göre AA'yı öngörmede daha yüksek tanısal performans sergilemiştir. AA'yı öngörmede SII için eşik değer >1316 olup, duyarlılık %85.8 ve özgüllük %72.5 olarak belirlenmiştir. Sonuç: Sistemik inflamasyon indeksleri, özellikle SII, gebelerde AA'yı ayırt etmede güçlü tanısal bir değere sahiptir. SII'nin hem Alvarado skoru hem de hastanede kalış süresi ile korelasyon göstererek NLR ve PLR'ye göre üstün doğruluk gösterdiği ve tanı ve prognoz belirteci olarak yararlı olduğunu düşündürmektedir.

Anahtar Kelimeler

• akut apandisit
• Alvarado skoru
• gebelik
• sistemik inflamasyon indeksleri
• sistemik immün-inflamasyon indeksi

Kaynakça

1. Nakashima M, Takeuchi M, and Kawakami K. Clinical Outcomes of Acute Appendicitis During Pregnancy: Conservative Management and Appendectomy. World J Surg. 2021;45(6):1717-24. DOI: 10.1007/s00268-021-06010-w.
2. Seok JW, Son J, Jung KU, Lee SR, and Kim HO. Safety of appendectomy during pregnancy in the totally laparoscopic age. J Minim Invasive Surg. 2021;24(2):68-75. DOI: 10.7602/jmis.2021.24.2.68.
3. Choi YS, Seo JH, Yi JW, Choe YM, Heo YS, and Choi SK. Clinical Characteristics of Acute Appendicitis in Pregnancy: 10-Year Experience at a Single Institution in South Korea. J Clin Med. 2023;12(9) DOI: 10.3390/jcm12093277.
4. Lotfipour S, Jason M, Liu VJ, et al. Latest Considerations in Diagnosis and Treatment of Appendicitis During Pregnancy. Clin Pract Cases Emerg Med. 2018;2(2):112-15. DOI: 10.5811/cpcem.2018.1.36218.
5. Somuncu E, Bozdag E, Sarici I, Ozcan A, Ozkan C, and Basaran C. The diagnostic role of hemogram parameters in pregnant appendicitis. Pol Przegl Chir. 2021;94(1):48-53. DOI: 10.5604/01.3001.0015.3961.
6. Theilen LH, Mellnick VM, Shanks AL, et al. Acute Appendicitis in Pregnancy: Predictive Clinical Factors and Pregnancy Outcomes. Am J Perinatol. 2017;34(6):523-28. DOI: 10.1055/s-0036-1593764.
7. Baskiran A, Ince V, Cicek E, et al. Efficacy of laboratory tests and ultrasonography in the diagnosis of acute appendicitis in gravid patients according to the stages of pregnancy. Ulus Travma Acil Cerrahi Derg. 2018;24(4):333-36. DOI: 10.5505/tjtes.2017.23693.
8. Wang H, Sun JL, Zhang ZL, and Pei HH. Pregnancy complicated with agranulocytosis. Medicine (Baltimore). 2016;95(52):e5717. DOI: 10.1097/MD.0000000000005717.

9. von Versen-Hoeynck FM, Hubel CA, Gallaher MJ, Gammill HS, and Powers RW. Plasma levels of inflammatory markers neopterin, sialic acid, and C-reactive protein in pregnancy and preeclampsia. Am J Hypertens. 2009;22(6):687-92. DOI: 10.1038/ajh.2009.54.
10. Cinar H, Aygun A, Derebey M, et al. Significance of hemogram on diagnosis of acute appendicitis during pregnancy. Ulus Travma Acil Cerrahi Derg. 2018;24(5):423-28. DOI: 10.5505/tjtes.2018.62753.
11. Yazar FM, Bakacak M, Emre A, et al. Predictive role of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for diagnosis of acute appendicitis during pregnancy. Kaohsiung J Med Sci. 2015;31(11):591-6. DOI: 10.1016/j.kjms.2015.10.005.
12. Akbas A, Aydin Kasap Z, Hacim NA, et al. The value of inflammatory markers in diagnosing acute appendicitis in pregnant patients. Ulus Travma Acil Cerrahi Derg. 2020;26(5):769-76. DOI: 10.14744/tjtes.2020.03456.
13. Peksoz R, Disci E, Kaya A, et al. Significance of laboratory parameters in diagnosing acute appendicitis during pregnancy. ANZ J Surg. 2022;92(1-2):121-27. DOI: 10.1111/ans.17443.
14. Guler I, Ozdemir U, Comcali B, Ozgurluk I, and Balci N. The Importance of Evaluating Hematologic Parameters in the Diagnosis of Acute Appendicitis Among Pregnant Patients. Eurasian Journal of Medical Investigation. 2023;7(4).
15. Feng Y, Miao C, and Zhao Y. Predicting Acute Appendicitis in Pregnant Patients Using the Neutrophil-to-Lymphocyte Ratio: A Meta-Analysis. Surg Infect (Larchmt). 2023;24(10):903-09. DOI: 10.1089/sur.2023.269.
16. Ilhan M, Ilhan G, Gok AF, Bademler S, Verit Atmaca F, and Ertekin C. Evaluation of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and red blood cell distribution width-platelet ratio as early predictor of acute pancreatitis in pregnancy. J Matern Fetal Neonatal Med. 2016;29(9):1476-80. DOI: 10.3109/14767058.2015.1051026.
17. Telafarli MA and Yeni M. The diagnostic value of the systemic immune-inflammatory index in acute appendicitis cases in the emergency department. Langenbecks Arch Surg. 2023;408(1):136. DOI: 10.1007/s00423-023-02871-y.
18. Gorter RR, Eker HH, Gorter-Stam MA, et al. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016;30(11):4668-90. DOI: 10.1007/s00464-016-5245-7.
19. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-22. DOI: 10.1158/1078-0432.CCR-14-0442.
20. Qi Q, Zhuang L, Shen Y, et al. A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy. Cancer. 2016;122(14):2158-67. DOI: 10.1002/cncr.30057.
21. Hernandez MC and Zielinski MD. Appendicitis in the Pregnant Patient: Risk, Diagnosis, Management, and Outcomes. Current Surgery Reports. 2021;9:1-8.
22. Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, and Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg. 2018;56:307-14. DOI: 10.1016/j.ijsu.2018.07.003.
23. Mantoglu B, Gonullu E, Akdeniz Y, et al. Which appendicitis scoring system is most suitable for pregnant patients? A comparison of nine different systems. World J Emerg Surg. 2020;15(1):34. DOI: 10.1186/s13017-020-00310-7.
24. Lim HK, Bae SH, and Seo GS. Diagnosis of acute appendicitis in pregnant women: value of sonography. AJR Am J Roentgenol. 1992;159(3):539-42. DOI: 10.2214/ajr.159.3.1503019.
25. Wang Z, Bao F, Liang W, et al. Appendicitis in pregnant women: A systematic review and meta-analysis of the diagnostic performance of ultrasonography. J Clin Ultrasound. 2023;51(9):1492-501. DOI: 10.1002/jcu.23566.
26. Shen G, Wang J, Fei F, Mao M, and Mei Z. Bedside ultrasonography for acute appendicitis: An updated diagnostic meta-analysis. Int J Surg. 2019;70:1-9. DOI: 10.1016/j.ijsu.2019.08.009.
27. Pedrosa I and Rofsky NM. MR imaging in abdominal emergencies. Radiol Clin North Am. 2003;41(6):1243-73. DOI: 10.1016/s0033-8389(03)00102-7.
28. Bardakci O, Bahcecioglu IB, Tatli F, Ozgonul A, Guldur ME, and Uzunkoy A. Does one of the two most commonly used scoring systems have a decisive advantage over the other in diagnosing acute appendicitis in pregnant women? Medicine (Baltimore). 2023;102(17):e33596. DOI: 10.1097/MD.0000000000033596.
29. Jung JY, Na JU, Han SK, Choi PC, Lee JH, and Shin DH. Differential diagnoses of magnetic resonance imaging for suspected acute appendicitis in pregnant patients. World J Emerg Med. 2018;9(1):26-32. DOI: 10.5847/wjem.j.1920-8642.2018.01.004.
30. Rajalingam VR, Mustafa A, Ayeni A, et al. The Role of Neutrophil-Lymphocyte-Ratio (NLR) and Platelet-Lymphocyte-Ratio (PLR) as a Biomarker for Distinguishing Between Complicated and Uncomplicated Appendicitis. Cureus. 2022;14(1):e21446. DOI: 10.7759/cureus.21446.
31. Barut B, Gönültaş F, Gök AFK, and Şahin TT. Management of acute cholecystitis during pregnancy: A single-center experience. Turkish Journal of Trauma & Emergency Surgery/Ulusal Travma ve Acil Cerrahi Dergisi. 2019;25(2).