Evaluation of CA-125 Biomarker in Acute Appendicitis Patients: Correlation with Clinical Symptoms and Lab Results

Abstract

Objectives: The aim of this study is to evaluate the diagnostic significance of CA 125 in Acute Appendicitis (AA) along with the changes in its levels about clinical symptoms and lab findings. Methods: Patients referred at the emergency department of Madani hospital with the suspicion of AA and right iliac fossa pain were enrolled in this study. Preoperative CA 125 levels along with C-reactive Protein (CRP) and complete blood count were obtained. Lab findings, signs and symptoms were recorded for all the patients. Statistical analysis was conducted based on CA 125 < 16.4 U/mL and ≥ 16.4 U/mL using the logistic regression model, where variables such as fever, anorexia, CRP and Erythrocyte Sedimentation Rate (ESR) were added to the model. Results: Of 207 patients with the mean age of 26.55 ± 0.967 years, 48.8% of them were males and 51.20% were females. 122 of the total patients had CA 125 ≥ 16.4 U/mL. Anorexia was significantly associated with increased levels of CA 125. CA 125 was 2.14 times higher in patients presenting anorexia. However, ESR, CRP and fever were not associated with the elevation of CA 125. Based on the contour plot, it was deduced that leukocytosis at its lowest and erythrocyte sedimentation rate at its highest levels is associated with the maximum concentration of serum CA 125. Conclusion: Based on the findings from this study, CA 125 cannot be considered as a reliable diagnostic variable for acute appendicitis. Levels of CA 125 may vary with the severity of AA.

Diagnostic performance of serum CA-125 for overall and complicated acute appendicitis: a systematic review and meta-analysis

“…The risk of bias concerning the index test was considered low in four of the studies [11][12][13][14] and unclear in one of them [15]. The risk of bias concerning the reference standard was considered low in four of the studies [11][12][13][14] and unclear in one of them [15]. The risk of bias concerning flow and timing was considered low in two of the studies [11,14], unclear in two of the studies [12,13] and high in one of them [15].…”

“…The risk of bias concerning flow and timing was considered low in two of the studies [11,14], unclear in two of the studies [12,13] and high in one of them [15]. Regarding applicability concerns, the risk was estimated as low in all articles except for Ahmadinejad et al, which was found to be unclear in all three categories [15]. The results of the QUADAS2 analysis are shown in Figure 2.…”

“…This was not the case for the definition of "control", which constituted either non-surgical abdominal pain [12], negative appendectomies [12,14], or healthy controls [13]. One study did not provide sufficient data to determine this information [15]. One study exclusively compared patients with uncomplicated AA (NCAA) and complicated AA (CAA) with no control group [11].…”

“…The reported measurement units for CA-125 were U/mL [11][12][13][14][15]. Following a standardized procedure, we converted the median (range) data Çetinkaya et al [11] to mean (standard deviation) [10].…”

Comparison of the prevalence of perforated appendicitis during and before COVID19 pandemic

“…Pandemic has caused to change trend in the management of a number of pathologies and diseases [ 14 , 15 ]. Following the increase in COVID19 cases, patients with acute illness such as myocardial infarctions, those requiring cardiac catheterization laboratory activations, and stroke have also reduced their visits to the hospital [ 16 , 17 ]. Due to reduction in non-emergent surgical procedures in COVID19 period, patients with acute appendicitis may have poor postoperative outcomes such as abscesses, prolonged hospitalization, and increased reoperations and readmissions [ 18 , 19 ].…”