Ulus Travma Acil Cerrahi Derg. 2017; 23(6): 477-482 | DOI: 10.5505/tjtes.2017.36605

Enflamatuvar belirteçlerin negatif apendektomi oranýný azaltmadaki rolü: Bilgisayarlý tomografi bulgularýna dayanan bir çalýþma

Ebru Ozan¹, Gökçe Kaan Ataç¹, Kaan Aliþar¹, Aslýhan Alhan^2
1Ufuk Üniversitesi Týp Fakültesi, Radyoloji Anabilim Dalý, Ankara
²Ufuk Üniversitesi Fen Edebiyat Fakültesi, Ýstatistik Bölümü, Ankara

AMAÇ: Bu çalýþmada enflamatvuar belirteçlerin negatif apendektomi oranýný düþürmedeki rolünün, akut apandisitin (AA) bilgisayarlý tomografi (BT) bulgularýna dayanarak araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Akut apandisit ön tanýsýyla BT incelemesi yapýlan 92 hastanýn bilgileri geriye dönük olarak tarandý. Enflamatvuar belirteçler ile BT bulgularý arasýndaki iliþki araþtýrýlarak, ROC analizi ile enflamatvuar belirteçler ve BT bulgularýna ait kesim deðerleri belirlendi. Apendektomi yapýlan olgular, bu kesim deðerlerine göre yeniden deðerlendirilerek negatif apendektomi oraný yeniden hesaplandý. Gerçek negatif apendektomi oraný ile yeniden hesaplanan negatif apendektomi oraný arasýndaki fark ki-kare testi kullanýlarak analiz edildi.
BULGULAR: Apendiks çapý, apendiks duvar kalýnlýðý ve çekum duvar kalýnlýðý için kesim deðerleri sýrasýyla, 7.9 mm, 2 mm ve 2.3 mm olarak bulundu. Beyaz küre sayýmý, nötrofil/lenfosit oraný ve C-reaktif protein için kesim deðerleri sýrasýyla, 7.47, 4.06 ve 13 olarak bulundu. Gerçek negatif apendektomi oraný ile kesim deðerlerine göre yeniden hesaplanan negatif apendektomi oraný arasýndaki istatistiksel fark neredeyse anlamlý idi (p=0.058).
TARTIÞMA: Enflamatvuar belirteçler AA kesin tanýsý için tek baþlarýna yetersizdir. Ancak, çalýþmamýzda bulunan kesim deðerleri, özellikle arada kalýnan olgularda, kesin taný için faydalý olarak negatif apendektomi oranýnýn düþürülmesine katký saðlayabilir.

Anahtar Kelimeler: Akut apandisit, bilgisayarlý tomografi, C-reaktif protein, negatif apendektomi oraný, nötrofil/lenfosit oraný.

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Role of inflammatory markers in decreasing negative appendectomy rate: A study based on computed tomography findings

Ebru Ozan¹, Gökçe Kaan Ataç¹, Kaan Aliþar¹, Aslýhan Alhan^2
1Department of Radiology, Ufuk University Faculty of Medicine, Ankara-Turkey
²Department of Statistics, Ufuk University Faculty of Arts and Sciences, Ankara-Turkey

BACKGROUND: This study aimed to investigate the role of inflammatory markers in decreasing negative appendectomy rate (NAR) based on their relation with findings of acute appendicitis (AA) on computed tomography (CT).
METHODS: Ninety-two patients who underwent CT examination with suspected AA were included. We investigated the relation between CT findings of AA and laboratory inflammatory markers and also performed receiver operating characteristic (ROC) analysis to calculate cut-off values of inflammatory markers and CT findings of AA. Appendectomy cases were re-evaluated considering cut-off values to make the operation decision and NAR was recalculated. Chi-squared test was used to compare the actual and recalculated NAR.
RESULTS: Cut-off values of appendiceal diameter, appendiceal wall thickness, and caecal wall thickness were 7.9, 2, and 2.3 mm, respectively, for the diagnosis of AA. Cut-off values of WBC, NLR, and CRP on ROC analysis were 7.47, 4.06 and 13, respectively, for the diagnosis of AA. When the actual and recalculated NAR (21.9% versus 9.1%) were compared, the difference was found to be almost significant (p=0.058).
CONCLUSION: Inflammatory markers are not sufficiently powerful on their own to accurately diagnose AA. However, particularly in equivocal cases, proposed cut-off values may be helpful for accurate diagnosis and a lower NAR can be achieved.

Keywords: Acute appendicitis, C-reactive protein, computed tomography, negative appendectomy rate, neutrophil to lymphocyte ratio.

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