Inflammatory parameters as predictive factors for complicated appendicitis: A retrospective cohort study

Abstract

Introduction Acute appendicitis is a major cause of acute abdomen. Although its diagnosis is clinical, it is often supported by complementary diagnostic tests. Sometimes, delay in diagnosis can lead to worsening of the clinical picture, resulting in a complicated acute appendicitis. Some series have studied some clinical and analytical parameters as possible predictors of complicated acute appendicitis. Study design A retrospective analysis of patients admitted for acute appendicitis and undergoing appendectomy between January 2014 and December 2017 was performed in order to assess the possible existence of preoperative analytical predictive factors for complicated acute appendicitis (such as leukocytosis, C-reactive protein and ratio between neutrophils and lymphocytes). Results 841 patients underwent emergency appendectomy during the analysed period. This initial sample was divided into two groups: Group 1 with patients with uncomplicated acute appendicitis and Group 2 with patients with complicated acute appendicitis. Group 2's presentation age, duration of symptoms and hospital stay was significantly higher than Group 1. Regarding analytical parameters, the measurement of leukocytes, C-reactive protein and ratio between neutrophils and lymphocytes was significantly higher in patients with complicated acute appendicitis. After a multivariate analysis, it was found that only C-reactive protein was a good predictor of complicated acute appendicitis. Conclusion Several publications have studied and demonstrated the possible use of certain analytical parameters as predictors of complicated acute appendicitis. In our study, C-reactive protein proved to be a good independent predictor of complicated acute appendicitis and, therefore, when an assay of this protein exceeds 63.3 mg/L, faster surgical approach should be considered due to the high probability of the presence of a complicated picture of this clinical entity.

Predictors of Complicated Appendicitis with Evolution to Appendicular Peritonitis in Pediatric Patients

“…Clinical examination identifying signs of peritoneal irritation and imaging studies showing signs of complicated conditions such as intra-abdominal abscesses, pneumoperitoneum, or free intra-abdominal liquid is useful, but the definitive diagnosis of perforated appendicitis still requires surgery and histological diagnosis [ 3 , 21 , 22 ]. Consistently throughout the literature, there are several factors indicating a high risk of perforated appendicitis, such as younger age at presentation, a longer duration of symptoms, and some non-specific manifestations such as anorexia and emesis [ 18 , 23 ]. Diffuse pain, generalized abdomen tenderness, fever, and peritoneal signs are most frequently present in perforated appendicitis compared to simple appendicitis [ 14 ].…”

“…The lag in diagnosis carries with it a high risk of gangrene, perforation, intra-abdominal abscess formation, peritonitis, and sepsis, thus increasing morbidity rates [ 2 , 16 ]. The surgeon has a hard choice between waiting to perform surgery until a complete diagnosis and operating soon after diagnosis to elude complications [ 17 , 18 ]. The preoperative difference between complicated and uncomplicated appendicitis may be difficult [ 19 , 20 ].…”

Appendiceal Diverticulitis Presenting as Acute Appendicitis and Diagnosed After Appendectomy

“…Worldwide, acute appendicitis is one of the most common general surgical emergencies, so appendectomy is one of the most frequently performed surgical operations. Luminal obstruction of the appendix (by a fecalith, impacted stool, lymphoid hyperplasia; infrequently by a tumor) causes acute appendicitis, but not all reasons are known [1,2]. Diverticular disease of the appendix (DDA) is a rare appendiceal pathology and incidence of 0.004-2.1% in appendectomy specimens.…”

Comment to: “Inflammatory parameters as predictive factors for complicated appendicitis: A retrospective cohort study”

“…We have read the valuable article titled “Inflammatory parameters as predictive factors for complicated appendicitis: A retrospective cohort study’’ by Ribeiro et al [ 1 ] with a great interest. In this article, the authors explained the situation of predicting the complexity of the appendix by looking at analytical predictive factors.…”

“…Firstly, Ribeiro et al [ 1 ] emphasized the importance of basic laboratory parameters such as complete blood count parameters (CBC) parameters and C-reactive protein (CRP). This basic labaratory parameters are affected by various factors, like chronic diseases, haematological diseases, allergic diseases, various drugs, malignant or inflammatory diseases [ 2 , 3 ].…”