Alterations of the preoperative coagulation profile in patients with acute appendicitis

Li, Jianxin; Liu, Yan; Wang, Yin; Zhang, Chuanzhou; Huang, Jinhe; Liao, Chaoyu; Nie, Liping; Zhou, Yu; Xiao, Ping

doi:10.1515/cclm.2011.214

Cited by 27 publications

(20 citation statements)

References 35 publications

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“…In septic patients, platelet counts tend to be lower when compared to healthy individuals, but not compared to post surgical or SIRS patients [12,39]. Perioperative systemic endotoxin concentrations do not correlate with platelet counts or aPPT [40,41]. Prothrombin time (PT) (in our study represented by INR) does not differ between controls, patients with sepsis or severe sepsis.…”

Section: Discussionmentioning

confidence: 81%

Systemic endotoxin activity correlates with clot formation: an observational study in patients with early systemic inflammation and sepsis

et al. 2013

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IntroductionInflammation and coagulation are closely linked, and both can be triggered by endotoxin. Thrombelastometry and impedance aggregometry are of diagnostic and predictive value in critically ill patients. In this observational study we investigated the correlation of endotoxin activity with thrombelasometric and aggregometric variables in patients with systemic inflammation.MethodsBased on a daily screening on a tertiary academic surgical ICU, patients, as soon as they fulfilled two or more criteria for systemic inflammatory response syndrome (SIRS), were included. In whole blood we performed endotoxin activity (EA) assay, thrombelastometry (ROTEM®) and impendance aggregometry (Multiplate®).ResultsIn total, 49 patients were included with a broad spread of EA levels of (median (minimum to maximum)) 0.27 (0.01 to 0.72), allowing expedient correlative analysis. Clot formation time (CFT) (263 s (60 to 1,438 s)) and clotting time (CT) (1,008 s (53 to 1,481 s)) showed a significant negative correlation with EA level (r = -0.38 (P < 0.005) and r = -0.29 (P < 0.05)). Positive correlations were found for alpha-angle (50° (17 to 78°), r = 0.40 (P < 0.005)) and maximum clot firmness (MCF) (55 mm (5/76), r = 0.27 (P < 0.05)). No significant correlations were found between Lysis Index at 60 minutes (LI60) and EA levels. There was no correlation between EA level and aggregometric values, or classical coagulation parameters.ConclusionsIn patients with systemic inflammation, increasing endotoxin concentrations correlate with increased clot formation.

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Section: Discussionmentioning

confidence: 81%

Systemic endotoxin activity correlates with clot formation: an observational study in patients with early systemic inflammation and sepsis

et al. 2013

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“…We encountered seven cases of DVT/PE after appendectomy in our center last year. Li et al observed endotoxin-induced activation of the extrinsic coagulation pathway in patients with acute appendicitis [4]. Other studies have identified inflammation as a risk factor for DVT [5].…”

Section: Introductionmentioning

confidence: 99%

Incidence of postsurgical pulmonary embolism and deep venous thrombosis: a single-center retrospective observational study

Otsuka¹,

Izumi²,

Ota³

et al. 2020

JA Clin Rep

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Background: Cancer is a risk factor for perioperative deep venous thrombosis and pulmonary embolism (DVT/PE). However, there is a paucity of data on non-malignant digestive diseases. In this study, we aimed to investigate the incidence of DVT/PE among patients, following surgery for acute appendicitis and other digestive diseases.Methods: We retrospectively reviewed the records of patients who underwent surgical procedures involving the digestive system between April 2018 and March 2019 attended by anesthesiologists (n = 536).Results: DVT/PE developed in seven patients (7/77, 9.1%, 95% confidence interval [CI] 3.7-17.8%) after surgery for acute appendicitis, and in six patients (6/83, 7.2%, 95%CI 2.7-15.1%) after elective surgery for colorectal cancer. Among the acute appendicitis group, six patients (6/30 20.0%) with complicated appendicitis (gangrenous or perforated appendicitis), and one patient (1/47 2.1%) with simple appendicitis showed postoperative DVT/PE. Patients with complicated appendicitis had a higher risk of DVT/PE than those with simple appendicitis with an odds ratio of 11.5 (95%CI 1.3-101.1). Conclusions:Although patients with acute appendicitis lack three of the risk factors for DVT/PE (cancer, long operative time, and older age), their 95% CI for the incidence of DVT/PE was comparable to that of patients undergoing elective surgery for colorectal cancer. Therefore, caution must be exercised during the perioperative period for preventing DVT/PE.

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“…White blood cell (WBC) count, absolute neutrophil count (ANC), and C-reactive protein (CRP) are the most studied and used in clinical practices. 7 Fibrinogen (FB) has been reported recently as a useful biomarker in the diagnosis of appendicitis, [8][9][10][11][12][13][14] but it has not been assessed specifically in the preschool age group. Since WBC and ANC in young children have a worst diagnostic accuracy to discriminate appendicitis than in older children, 7 it would be interesting to identify more useful inflammatory markers in this group of patients.…”

Section: Introductionmentioning

confidence: 99%

Value of Fibrinogen to Discriminate Appendicitis from Nonspecific Abdominal Pain in Preschool Children

et al. 2019

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Aim The aim of this study was to assess the diagnostic value of the biomarker fibrinogen (FB), along with the markers white blood cell (WBC) count, absolute neutrophil count (ANC), and C-reactive protein (CRP), to discriminate appendicitis from nonspecific abdominal pain (NSAP) in preschool children. Materials and Methods We prospectively evaluated all children aged <5 years admitted for suspected appendicitis at an academic pediatric emergency department during 5 years. Diagnostic accuracy of FB (prothrombin time–derived method), WBC, ANC, and CRP were assessed by the area under the curve (AUC) of the receiver-operating characteristic curve. Results A total of 82 patients were enrolled in the study (27 NSAP, 17 uncomplicated, and 38 complicated appendicitides). WBC and ANC had moderate diagnostic accuracy for appendicitis versus NSAP (WBC: AUC 0.66, ANC: AUC 0.67). CRP and FB had good diagnostic accuracy for appendicitis versus NSAP (CRP: AUC 0.78, FB: AUC 0.77). WBC and ANC are not useful to discriminate complicated versus uncomplicated appendicitis (WBC: AUC 0.43, ANC: AUC 0.45). CPR and FB had good diagnostic accuracy for complicated versus uncomplicated appendicitis (CRP: AUC 0.80, FB: AUC 0.73). Conclusion CRP and FB are more useful than WBC and ANC to discriminate appendicitis from NSAP in preschool children. CRP and FB are especially useful to discriminate complicated from uncomplicated appendicitis and NSAP. In a child with suspected appendicitis, a plasma FB level (prothrombin time–derived method) >540 mg/dL is associated with an increased likelihood of complicated appendicitis.

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Alterations of the preoperative coagulation profile in patients with acute appendicitis

Abstract: Endotoxin-induced activation of the extrinsic coagulation pathway was present in patients with AA. Fib may be useful as a potential indicator for excluding complicated appendicitis.

Cited by 27 publications

References 35 publications

Systemic endotoxin activity correlates with clot formation: an observational study in patients with early systemic inflammation and sepsis

Systemic endotoxin activity correlates with clot formation: an observational study in patients with early systemic inflammation and sepsis

Incidence of postsurgical pulmonary embolism and deep venous thrombosis: a single-center retrospective observational study

Value of Fibrinogen to Discriminate Appendicitis from Nonspecific Abdominal Pain in Preschool Children

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