High C-reactive protein level as a predictor for appendiceal perforation

BACKGROUND: Between 18% and 34% of acute appendicitis (AA) patients may have complicated appendicitis. Perforation is the most important complication of AA. Perforation increases morbidity and mortality. In this study, we aimed to investigate the role of basic inflammatory markers in the diagnosis of perforated AA.
METHODS: A retrospective chart review was conducted of patients who underwent appendectomy with a diagnosis of AA between January 2014 and October 2019 at Akdeniz University Faculty of Medicine; and between December 2017 and October 2019 at Istinye University Faculty of Medicine Hospital. Markers recorded were as follows: white blood cell count, neutrophils, lymphocytes, platelets, c-reactive protein, mean platelet volume, red cell distribution width and eosinophils. Hematological indices were combined to generate the following three ratios: white cell neutrophil ratio, platelet lymphocyte ratio and neutrophil-lymphocyte ratio.
RESULTS: A total of 536 patients with a diagnosis of AA underwent an operation. There were 344 (64.1%) male patients and 192 (35.9%) female patients. The mean age of the patients was 36.7±16.2 (15-88) years. There were 94 (17.5%) patients with perforated AA and 442 (82.5%) patients with non-perforated AA. C-reactive protein (AUC: 0.81, p<0.001) was the most accurate markers in distinguishing the perforated and non-perforated group.
CONCLUSION: Elevated CRP level is a nonspecific inflammatory marker in most of the inflammatory diseases. A high CRP level can, therefore, be used as a supplement in the diagnosis of perforated AA.

Yüksek C-reaktif protein seviyesi apendiks perforasyonu için belirteç olabilir

AMAÇ: Akut apandisit (AA) hastalarýnýn %18 ile %34’ü komplike apandisit tanýsý almýþtýr. AA’nýn en önemli komplikasyonu perforasyondur. Perforasyon morbidite ve mortaliteyi arttýrýr. Bu çalýþmada temel enflamatuvar belirteçlerin perfore AA tanýsýndaki rolünü araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Akdeniz Üniversitesi Týp Fakültesi’nde; Ocak 2014–Ekim 2019 ve Aralýk 2017–Ekim 2019 tarihleri arasýnda Ýstinye Üniversitesi Týp Fakültesi Hastanesi’nde AA tanýsý ile apendektomi yapýlan hastalarýn retrospektif dosya incelemesi yapýldý. Kaydedilen belirteçler aþaðýdaki gibiydi: lökosit sayýsý, nötrofil, lenfosit, trombosit sayýmý, C-reaktif protein, ortalama trombosit hacmi, kýrmýzý hücre daðýlým geniþliði ve eozinofiller. Aþaðýdaki üç oranýn üretilmesi için hematolojik endeksler çalýþtýrýldý; beyaz küre nötrofil oraný, trombosit lenfosit oraný ve nötrofil lenfosit oraný.
BULGULAR: Akut apandisit tanýsý olan toplam 536 hasta ameliyat edildi. Bu hastalarýn 344’ü (%64.1) erkek ve 192’si (%35.9) kadýn idi. Hastalarýn yaþ ortalamasý 36.7±16.2 (15–88) idi. Perfore AA olan 94 (%17.5) ve perfore olmayan AA olan 442 (%82.5) hasta vardý. C-reaktif protein (AUC: 0.81, p<0.001), perfore ve perfore olmayan grubun ayýrt edilmesinde en doðru belirteç olarak tespit edildi.
TARTIÞMA: Yüksek CRP seviyesi, enflamatuvar hastalýklarýn çoðunda spesifik olmayan bir enflamatuvar belirteçtir, bu nedenle yüksek CRP seviyesi, perfore AA’nýn tanýsýnda bir tamamlayýcý olarak kullanýlabilir.