Ulus Travma Acil Cerrahi Derg. 2022; 28(11): 1590-1596 | DOI: 10.14744/tjtes.2021.13472

Effectiveness of pre-operative routine blood tests in predicting complicated acute appendicitis

Server Sezgin Uludað, Ozan Akýncý, Nazim Güreþ, Emre Tunç, Ergin Erginöz, Ahmet Necati Þanlý, Abdullah Kaðan Zengin, Mehmet Faik Özçelik
Department of General Surgery, Ýstanbul University Cerrahpaþa - Cerrahpaþa Faculty of Medicine, Ýstanbul-Türkiye

BACKGROUND: Early prediction and diagnosis of perforation in acute appendicitis allow surgeons to choose the most appropriate treatment. The purpose of this study is to evaluate whether pre-operative routine laboratory examinations have a role in predicting complicated acute appendicitis.
METHODS: In the study, 783 patients operated with the diagnosis of acute appendicitis between the years 2014 and 2019 were analyzed retrospectively. Among the patients with non-perforated and perforated acute appendicitis, pre-operative laboratory tests include leukocyte (WBC), neutrophil, lymphocyte, platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP), and neutrophil-to-lymphocyte rate (NLR) parameters were compared.
RESULTS: Appendicitis was not detected histopathologically in 81 cases. In the study, 89.9% (n=631) of the 702 patients were non-perforated and 10.1% (n=71) were perforated acute appendicitis cases. Perforation rate was higher in elderly patients (p<0.01). It was seen that lymphocyte count was significantly lower in the perforated group, and CRP and NLR were significantly higher (p=0.048, p=0.001, p=0.028, respectively). In the diagnosis of perforated acute appendicitis, cutoff values were 44.0 mg/dL for CRP, 7.65 for NLR and 1.7/mm3 for lymphocytes. There was no statistical difference between the groups in terms of WBC, neutrophil, PLT, MPV, and PDW values.
CONCLUSION: Low lymphocyte count, high CRP, and high NLR were found to be reliable and strong predictive parameters in the diagnosis of complicated acute appendicitis.

Keywords: Complicated appendicitis, C-reactive protein, lymphocyte, neutrophil-to-lymphocyte rate.

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Komplike akut apandisiti öngörmede ameliyat öncesi rutin kan testlerinin etkinliði

Server Sezgin Uludað, Ozan Akýncý, Nazim Güreþ, Emre Tunç, Ergin Erginöz, Ahmet Necati Þanlý, Abdullah Kaðan Zengin, Mehmet Faik Özçelik
Ýstanbul Üniversitesi Cerrahpaþa - Cerrahpaþa Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul

AMAÇ: Akut apandisitte perforasyonun erken tahmini ve teþhisi cerrahlarýn en uygun tedaviyi seçmesine olanak tanýr. Bu çalýþmanýn amacý, ameliyat öncesi rutin laboratuvar incelemelerinin komplike akut apandisiti öngörmede rolü olup olmadýðýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmada 2014–2019 yýllarý arasýnda akut apandisit tanýsý ile ameliyat edilen 783 hasta geriye dönük olarak incelendi. Perfore olmayan ve perfore akut apandisiti olan hastalar arasýnda ameliyat öncesi laboratuvar testleri arasýnda lökosit (WBC), nötrofil, lenfosit, trombosit (PLT), ortalama trombosit hacmi (MPV), trombosit daðýlým geniþliði (PDW), C-reaktif protein bulunur. Çalýþmada CRP ve nötrofil-lenfosit oraný (NLR) parametreleri karþýlaþtýrýlmýþtýr.
BULGULAR: Toplam 81 olguda histopatolojik olarak apandisit saptanmamýþtýr. Çalýþmada 702 hastanýn %89.9’u (n=631) perfore bulunmamýþtýr, %10.1’i (n=71) perfore akut apandisit tanýsý almýþtýr. Yaþlý hastalarda perforasyon oraný daha yüksek bulunmuþtur (p<0.01). Lenfosit sayýsýnýn perfore grupta anlamlý olarak daha düþük olduðu, CRP ve NLR’nin anlamlý olarak yüksek olduðu görüldü (sýrasýyla p=0.048, p=0.001, p=0028). Perfore akut apandisit tanýsýnda eþik deðerleri CRP için 44.0 mg/dL, NLR için 7.65 ve lenfositler için 1.7/mm3 idi. Gruplar arasýnda WBC, nötrofil, PLT, MPV ve PDW deðerleri açýsýndan istatistiksel olarak fark yoktu.
TARTIÞMA: Düþük lenfosit sayýsý, yüksek CRP ve yüksek NLR, komplike akut apandisit tanýsýnda güvenilir ve güçlü prediktif parametreler olarak bulunmuþtur.

Anahtar Kelimeler: CRP, komplike apandisit, lenfosit, NLR.

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