Preoperative Analytical Predictors of Complicated Acute Appendicitis Myth or Reality of Predictive Scores?

Abstract

Introduction Acute appendicitis (AA) is the most frequent surgical emergency. Clinical and analytical parameters are the diagnostic basis. We analyze the predictive value of inflammatory markers (IM) and their relationship with complicated appendicitis (cAA), identifying a predictive SCORE. Methods Retrospective observational analysis of 484 patients > 14 years operated on for AA at a tertiary center between 2017–2019. 2 groups according to intraoperative findings in complicated and uncomplicated appendicitis (ncAA). Univariate logistic regression analysis was performed to evaluate the predictive ability of leukocyte count (LC), percentage of neutrophils (PN), CRP and polyglobulia) creating a multivariable predictive model. Results 83.7% <65 years, with ultrasonography being the most frequent diagnostic study and laparoscopy the preferred route of approach. 43.30% (207) complicated vs 54.81% (262) uncomplicated. Both LC and PN and CRP present statistically significant associations with complicated appendicitis, with a cut-off point of LC >18,990, PN >61.8% and CRP >5.05 respectively, while polyglobulia is related to less complication OR 0.63% (p 0.01402). According to the multivariable model 1/ [1 + e - (- 4.45–0.000003 * leukocytes + 0.043 * neutrophil percentage + 0.138 * CRP - 0.028 (if red series anemia) - 1.031 (if red series polyglobulia))] good predictive capacity is evidenced. Harrel's C corrected index of 0.743 CI95% (0.69%-0.78%). Conclusions Elevation of IM is associated with cAA. The predictive ability of the described SCORE is acceptable, and useful in surgical planning. Prospective validation is needed.