An investigation into the factors predicting acute appendicitis and perforated appendicitis

BACKGROUND: To investigate the factors predicting acute appendicitis (AAp) and perforated AAp in patients who underwent surgery with a preliminary diagnosis of AAp.
METHODS: Between May 2009 and December 2018, 1316 patients underwent appendectomy with a presumed diagnosis of AAp. To investigate the factors predicting AAp, patients were divided into two groups considering the histopathological presence of inflammatory changes in the appendix: AAp positive (AAp group; n=1043) and AAp negative (Non-AAp group; n=273). Also, to investigate the factors predicting appendiceal perforation, patients with AAp were divided into two groups considering the presence of perforation: non-perforated AAp (n=850) and perforated AAp (n=193). ROC curve analysis was used to identify optimum cut-off values of quantitative variables. The groups were compared using univariate analysis methods and parameters with a p≤ 0.20 were taken into a multivariate logistic regression model.
RESULTS: Multivariate analysis method related to factors predicting AAp showed that gender (male; p=0.034; OR=1.4), WBC (≥10.900; p=0.022; OR=1.5), MPV (≥29.1; p=0.006; OR=1.6), TBil (≥0.61; p=0.034; OR=1.4), CRP (≥0.725; p=0.002; OR=1.7), NLR (≥5.13; p=0.034; OR=1.5), PNR (<24.04; p=0.001; OR=1.9) and US findings (AAp+; p<0.001; OR=2.9) were independent factors for predicting AAp. Multivariate analysis method related to factors predicting appendiceal perforation showed that age (≥32 years; p<0.001; OR=2.5), TBil (≥0.67; p=0.046; OR=1.5), CRP (≥3.75; p<0.001; OR=3.0) and NLR (≥5.69; p=0.006; OR=1.8) were independent factors for predicting perforated AAp.
CONCLUSION: We believe that predicting both AAp and perforation will help the clinician evaluate patients who applied to the emergency unit with presumed diagnosis AAp. This approach will also contribute to reducing the negative appendectomy and perforation rates.

Akut apandisit ve perfore apandisiti öngören faktörlerin belirlenmesi

AMAÇ: Akut apandisit (AAp) ön tanýsýyla ameliyata alýnan hastalarda AAp ve perfore AAp’yi öngören faktörlerin belirlenmesidir.
GEREÇ VE YÖNTEM: Mayýs 2009 ile Aralýk 2018 arasýnda 1316 hastaya AAp ön tanýsýyla apandektomi yapýldý. AAp’yi öngören faktörlerin belirlenmesi için apendiks’teki enflamatuvar deðiþikliklerin varlýðý gözönünde bulundurularak hastalar iki gruba ayrýldý: AAp (AAp grubu; n=1043) ve normal appendiks (Non-AAp; n=273). Ayrýca apendiks perforasyonunu öngören faktörlerin belirlenmesi için AAp tespit edilen hastalar perforasyon varlýðý gözönünde bulundurularak iki gruba ayrýldý: AAp (AAp grubu; n=850) ve perfore AAp grubu (perfore AAp grubu; n=193). Kantitatif deðiþkenler için optimal kesim noktalarýnýn belirlenmesi için ROC eðri analizi kullanýldý. Gruplar univariate analiz yöntemelri ile karþýlaþtýrýldý ve p≤0.20 deðeri alan deðiþkenler multivariate alojistik regresyon modeline (backward stepwise) alýndý.
BULGULAR: AAp’yi öngören faktörlerin belirlenmesi için yapýlan multivariate analiz cinsiyet (erkek; p=0.034; OR: 1.42), WBC (≥10.900; p=0.022; OR: 1.52), MPV (≥29.1; p=0.006; OR: 1.57), TBil (≥0.61; p=0.034; OR: 1.42), CRP (≥0.725; p=0.002; OR: 1.71), NLR (≥5.13; p=0.034; OR: 1.50), PNR (≥24.04; p=0.001; OR: 0.53) ve US bulgularýnýn (AAp+; p<0.001; OR: 2.88) AAp’yi öngörmede baðýmsýz birer faktör olduðunu göstermiþtir. Apendiks perforasyonunu öngören faktörlerin belirlenmesi için yapýlan multivariate analiz yaþ (≥32 yýl; p<0.001; OR: 2.54), TBil (≥0.67; p=0.046; OR: 1.46), CRP (≥3.75; p<0.001; OR: 2.99) ve NLR (≥5.69; p=0.006; OR: 1.84) perforasyonu öngörmede baðýmsýz birer faktör olduðunu göstermiþtir.
TARTIÞMA: Hem AAp hem de perforasyonun öngörülmesinin, acil servise AAp ön tanýsýyla baþvuran hastalarýn deðerlendirmesinde klinisyene yardýmcý olacaðýna inanýyoruz. Bu yaklaþým ayný zamanda negatif apendektomi ve perforasyon oranlarýnýn azaltýlmasýna katkýda bulunacaktýr.