Predictive value of serum sodium level in determining perforated appendicitis

BACKGROUND: The aim of the study was to investigate the predictive value of hyponatremia as a new biochemical marker for the early and accurate preoperative diagnosis of complicated appendicitis in the adult population.
METHODS: 732 patients who were operated for acute appendicitis (AA) and diagnosed as perforation intraoperatively were evaluated retrospectively. Serum sodium, C-reactive protein (CRP), and leukocyte levels of patients with perforated and nonperforated appendicitis were compared.
RESULTS: Perforated appendicitis patients had statistically lower serum Na values (p<0.001). Similarly, patients without perforated appendicitis had higher serum CRP values (p<0.001). In patients diagnosed with perforated AA, the sensitivity of plasma sodium concentration was 63%, and the specificity was 66%. The threshold value of plasma sodium concentration ≤137.5 mEq/L had the best possible sensitivity and specificity.
CONCLUSION: Hyponatremia is a new marker of perforated appendicitis and therefore, serum sodium level measurement should be considered in patients with a clinical presentation consistent with appendicitis if complications are suspected.

Perfore apandisit belirlemede serum sodyum düzeyinin öngörü deðeri

AMAÇ: Komplike apandisitin erken ve doðru ameliyat öncesi tanýsý için yeni bir biyokimyasal belirteç olarak hiponatreminin eriþkin popülasyonunda prediktif deðerinin araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Akut apandisit tanýsý ile ameliyat edilen ve intraoperatif olarak perforasyon tanýsý alan 732 hasta geriye dönük olarak deðerlendirildi. Perfore ve perfore olmayan apandisitli hastalarýn serum sodyum, C-reaktif protein (CRP) ve lökosit deðerleri karþýlaþtýrýldý.
BULGULAR: Perfore apandisit hastalarý istatistiksel olarak daha düþük serum Na deðerlerine sahipti (p<0.001). Buna benzer olarak perfore apandisit hastalarý olmayanlara göre daha yüksek serum CRP deðerlerine sahipti (p<0.001). Perfore akut apandisit tanýsý konan hastalarda plazma sodyum konsantrasyonunun duyarlýlýðý %63, özgüllüðü %66 idi. Plazma sodyum konsantrasyonunun ≤137.5 mEq/L eþik deðeri, mümkün olan en iyi duyarlýlýðý ve özgüllüðe sahipti.
TARTIÞMA: Hiponatremi, perfore apandisitin yeni bir belirtecidir ve bu nedenle apandisit ile uyumlu klinik prezentasyonu olan hastalarda komplikasyon þüphesi var ise serum sodyum düzeyi ölçümü dikkate alýnmalýdýr.