Inflammatory parameters as predictive factors for complicated appendicitis: A retrospective cohort study

Ana Matos Ribeiro; Inês Romero; Carlos Costa Pereira; Filomena Soares; Álvaro Gonçalves; Susana Costa; João Barros da Silva

doi:10.1016/j.amsu.2022.103266

Inflammatory parameters as predictive factors for complicated appendicitis: A retrospective cohort study

Ann Med Surg (Lond). 2022 Jan 19:74:103266. doi: 10.1016/j.amsu.2022.103266. eCollection 2022 Feb.

Authors

Ana Matos Ribeiro¹, Inês Romero¹, Carlos Costa Pereira², Filomena Soares¹, Álvaro Gonçalves¹, Susana Costa¹, João Barros da Silva¹

Affiliations

¹ Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.
² Hospital de Braga, Braga, Portugal.

Abstract

Introduction: Acute appendicitis is a major cause of acute abdomen. Although its diagnosis is clinical, it is often supported by complementary diagnostic tests. Sometimes, delay in diagnosis can lead to worsening of the clinical picture, resulting in a complicated acute appendicitis. Some series have studied some clinical and analytical parameters as possible predictors of complicated acute appendicitis.

Study design: A retrospective analysis of patients admitted for acute appendicitis and undergoing appendectomy between January 2014 and December 2017 was performed in order to assess the possible existence of preoperative analytical predictive factors for complicated acute appendicitis (such as leukocytosis, C-reactive protein and ratio between neutrophils and lymphocytes).

Results: 841 patients underwent emergency appendectomy during the analysed period. This initial sample was divided into two groups: Group 1 with patients with uncomplicated acute appendicitis and Group 2 with patients with complicated acute appendicitis. Group 2's presentation age, duration of symptoms and hospital stay was significantly higher than Group 1. Regarding analytical parameters, the measurement of leukocytes, C-reactive protein and ratio between neutrophils and lymphocytes was significantly higher in patients with complicated acute appendicitis. After a multivariate analysis, it was found that only C-reactive protein was a good predictor of complicated acute appendicitis.

Conclusion: Several publications have studied and demonstrated the possible use of certain analytical parameters as predictors of complicated acute appendicitis. In our study, C-reactive protein proved to be a good independent predictor of complicated acute appendicitis and, therefore, when an assay of this protein exceeds 63.3 mg/L, faster surgical approach should be considered due to the high probability of the presence of a complicated picture of this clinical entity.

Keywords: Acute appendicitis; C-reactive protein; Ileocecal appendix; Leukocytosis; Predictive factors; Ratio between neutrophils and lymphocytes.