Predictive Markers of Tubo-Ovarian Abscess in Pelvic Inflammatory Disease

Lee, Suk Woo; Rhim, Chae Chun; Kim, Jang Heub; Lee, Sung Jong; Yoo, Sun Hong; Kim, Shin Young; Hwang, Young Bin; Shin, So Young; Yoon, Joo Hee

doi:10.1159/000381772

Cited by 17 publications

(12 citation statements)

References 27 publications

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“…We observed higher mean values for WBCs, CRP, and ESR (all inflammatory markers) in the surgical intervention group than in the conservative group. The frequency of fever above 38℃ and peak fever during admission were not statistically different between the groups, which accords with the results of previous studies (11) (14). To our knowledge, this is the first report of the value of inflammatory markers obtained during hospitalization for predicting antibiotic treatment failure in patients with TOA.…”

Section: Discussionsupporting

confidence: 91%

The prediction of surgical intervention in patients with tubo-ovarian abscess

Hwang

Kim

2020

Preprint

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Background: The prediction of antibiotic treatment failure is helpful to identify patients with a high likelihood of needing surgical treatment early in patients diagnosed with tubo-ovarian abscess (TOA). The aim of this study was to compare the clinical characteristics of patients with TOA) who responded to medical treatment and those who underwent surgical intervention due to medical treatment failure. Material and Methods: Electronic medical records were evaluated retrospectively to identify patients who were diagnosed with TOA and hospitalized in our obstetrics and gynecology department between March 2014 and June 2019. Demographic, clinical, and laboratory data including white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were compared between the medical treatment group and the surgical intervention group. Logistic regression was used to determine the independent predictors of treatment failure. Results: Patient age, TOA diameter, WBC count, CRP, and ESR were significantly different between the groups. On multiple regression analysis, significant correlations were identified between age ( p = 0.001), ESR ( p = 0.045), and failure of medical treatment. TOA diameter ( p = 0.065) showed a borderline association with surgical intervention. The risk group was defined as the combination of factors producing a risk score > 2. The area under the curve (AUC) for the risk group (age >34.3 years, ESR > 45 mm/h, and TOA size > 5.9 cm) was 0.844. The sensitivity, specificity, accuracy, PPV, and NPV were 93.8%, 75%, 83.3%, 75%, and 93.8%, respectively. Conclusions: The risk of needing surgical intervention in TOA patients can be predicted using ESR in addition to age and TOA size as risk factors.

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Section: Discussionsupporting

confidence: 91%

The prediction of surgical intervention in patients with tubo-ovarian abscess

Hwang

Kim

2020

Preprint

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“…Timely administration of antibiotics or interventional drainage are crucial for a patient’s reproductive function. It is therefore imperative for clinicians to identify patients with TOA and differentiate it from ovarian malignancy, in order to obviate unnecessary resection or chemotherapy [ 8 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Tubo-Ovarian Abscess (with/without Pseudotumor Area) Mimicking Ovarian Malignancy: Role of Diffusion-Weighted MR Imaging with Apparent Diffusion Coefficient Values

Wang

et al. 2016

PLoS ONE

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ObjectiveTo assess the added value of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) values compared to MRI, for characterizing the tubo-ovarian abscesses (TOA) mimicking ovarian malignancy.Materials and MethodsPatients with TOA (or ovarian abscess alone; n = 34) or ovarian malignancy (n = 35) who underwent DWI and MRI were retrospectively reviewed. The signal intensity of cystic and solid component of TOAs and ovarian malignant tumors on DWI and the corresponding ADC values were evaluated, as well as clinical characteristics, morphological features, MRI findings were comparatively analyzed. Receiver operating characteristic (ROC) curve analysis based on logistic regression was applied to identify different imaging characteristics between the two patient groups and assess the predictive value of combination diagnosis with area under the curve (AUC) analysis.ResultsThe mean ADC value of the cystic component in TOA was significantly lower than in malignant tumors (1.04 ± 0 .41 × 10−3 mm2/s vs. 2.42 ± 0.38 × 10−3 mm2/s; p < 0.001). The mean ADC value of the enhanced solid component in 26 TOAs was 1.43 ± 0.16×10−3mm2/s, and 46.2% (12 TOAs; pseudotumor areas) showed significantly higher signal intensity on DW-MRI than in ovarian malignancy (mean ADC value 1.44 ± 0.20×10−3 mm2/s vs.1.18 ± 0.36 × 10−3 mm2/s; p = 0.043). The combination diagnosis of ADC value and dilated tubal structure achieved the best AUC of 0.996. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI vs. DWI with ADC values for predicting TOA were 47.1%, 91.4%, 84.2%, 64%, and 69.6% vs. 100%, 97.1%, 97.1%, 100%, and 98.6%, respectively.ConclusionsDW-MRI is superior to MRI in the assessment of TOA mimicking ovarian malignancy, and the ADC values aid in discriminating the pseudotumor area of TOA from the solid portion of ovarian malignancy.

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“…IUD use has been associated with poor prognosis and is a predictive factor of TOA in acute PID in one study, while other recent studies found no correlation [4,6,7]. We can suggest several reasons for the discrepancy between studies.…”

Section: Amongmentioning

confidence: 64%

“…Age was also reported as an independent factor predictive of TOA in acute PID, with an age exceeding 35 years old a benchmark that strongly correlated with an increase in the risk for PID surgery as a result of failed conservative treatment [6,7]. The present pregnancy, and admission diagnosis of tubo-ovarian abscess (TOA) on admission.…”

Section: Discussionmentioning

confidence: 98%

“…Age, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), previous intrauterine surgery, presence of endometriosis, and intrauterine device (IUD) use have been implicated as relevant prognostic factors in some studies but sometimes controversial results have been reported [4][5][6][7][8][9][10][11][12][13][14]. Furthermore, in recent studies, mean platelet volume (MPV) in patients with PID were lower than those in the control group and platelet indices were noted to be factors related to some inflammatory diseases [15][16][17][18][19] Among the factors mentioned above, elevated ESR and CRP values have been reported to be main prognosis predictors of PID but the cut-off values for these reads have not been accurately determined.…”

Section: Introductionmentioning

confidence: 99%

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Prognosis Predictors of Pelvic Inflammatory Disease among the Hospitalized Patients

Lee¹,

Hwang²

2016

Gynecol Obstet

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Introduction: Serious reproductive health consequences linked to pelvic inflammatory disease (PID) include infertility and ectopic pregnancy. Thus, it is important to identify patients likely to have a poor prognosis in choosing the best initial treatment. The aim of our study was to identify the valuable prognosis predictors of PID among the hospitalized patients and determined cut off values of quantitative independent prognosis predictors. Material and methods:Hospital records for women hospitalized with PID were retrospectively examined. The PID patients were divided into two sub-groups according to their clinical outcome. Prognostic factors were evaluated by T-test, χ2-test, and logistic regression analysis. The cut-off values of age, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and ESR combined with CRP were calculated by receiver-operator curve analysis.Results: Independent prognosis predictors of PID were advanced age (OR=1.031, 95% CI=1.002-1.062; P=0.036), elevated ESR (OR=1.029, 95% CI=1.013-1.046; P<0.001), increased CRP (OR=1.096, 95% CI=1.027-1.169; P=0.006), and presence of endometriosis (OR=5.700, 95% CI=1.123-28.943; P=0.025). The cut-off values of age, ESR, CRP, and ESR combined with CRP were 35 years, 30.5 mm/hr, 7.0 mg/dL, and 25 mm/hr and 6.5 mg/ dL respectively. Conclusions:The initial treatment of patients who are elderly, and/or who have endometriosis, elevated ESR, or increased CRP should be carefully decided. Evaluation of ESR together with CRP is recommended to gain a more accurate prediction of disease outcome.

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Predictive Markers of Tubo-Ovarian Abscess in Pelvic Inflammatory Disease

Cited by 17 publications

References 27 publications

The prediction of surgical intervention in patients with tubo-ovarian abscess

The prediction of surgical intervention in patients with tubo-ovarian abscess

Tubo-Ovarian Abscess (with/without Pseudotumor Area) Mimicking Ovarian Malignancy: Role of Diffusion-Weighted MR Imaging with Apparent Diffusion Coefficient Values

Prognosis Predictors of Pelvic Inflammatory Disease among the Hospitalized Patients

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