Biomarkers of Acute Appendicitis Severity: Diagnostic Test Study
Download PDF
$currentUrl="http://$_SERVER[HTTP_HOST]$_SERVER[REQUEST_URI]"

Keywords

Appendicitis
Perforation
Biomarkers
Severity
Acute appendicitis

DOI

10.26689/otd.v1i1.4030

Submitted : 2023-04-26
Accepted : 2023-05-11
Published : 2023-05-26

Abstract

Appendicitis (AA) is one of the most frequent abdominal surgical pathologies in the world, with appendectomy being the most frequently performed emergency surgery worldwide. This study was conducted to determine the possible biomarkers to detect the severity in AA for diagnostic purposes, and for the timely management of appendicitis and, thereby avoiding possible complications. This research was conducted based on a randomized sampling, where a total of 239 patients diagnosed with AA at the Hospital Regional de Orinoquia, Colombia was recruited for this study. Blood count, C–reactive protein (CRP), and neutrophil/lymphocyte ratio (NLR) records were analyzed, further their relationship with the surgical findings of AA described by Guzman–Valdivia was established. The study showed that, in the emergency department, these reactants are capable of making an approximate diagnosis and as biomarkers of the severity of AA, with CRP>15mg/dL (diagnostic accuracy 76.15%), and the percentage of neutrophils>85% (diagnostic accuracy 61.09%) being the best initial operative performance. For complications, such as intestinal perforation, CRP>15mg/dL and neutrophil percentage>85% were found statistically to be the biomarkers with the highest predictive performance, with OR 14.46, and OR 2.17, respectively, which is consistent with the findings described by Guzman–Valdivia. In conclusion, elevated level of CRP and neutrophil percentage>85 is the acute phase reactants with the best diagnostic characteristics and predictors of possible complications of AA.

References

Bahena-Aponte JA, Chavez-Tapia NC, Mendez-Sanchez N, 2003, Estado Actual de la Apendicitis (Current Status of Appendicitis). Med Sur, 2003(10): 122–128.

Huacuja-Blanco RR, Ruiz-Campos M, Lemus-Ramirez RI, et al., 2015, Factores Predictores Para Apendice Blanca y Apendicitis Aguda en Pacientes Sometidos a Apendicectomia. Experiencia de dos Anos en una Institucion Privada (Predictors of White Appendix and Acute Appendicitis in Patients Undergoing Appendectomy. Two-year Experience in a Private Institution). Med Sur, 2015(22): 11–18.

Benito J, Fernandez S, Gendive M, et al., 2020, A New Clinical Score to Identify Children at Low Risk for Appendicitis. Am J Emerg Med, 2020(38): 554–561.

Beltran MA, Almonacid FJ, Vicencio A, et al., 2007, Rol del Recuento de Leucocitos y de la Proteina C Reactiva en Ninos Con Apendicitis (Role of Leukocyte Count and C-Reactive Protein in Children with Appendicitis). Rev Chil Cir, 2007(59): 38–45.

Cuervo JL, 2014, Apendicitis Aguda (Acute Appendicitis). Rev Hosp Ninos, 2014(56): 15-31.

Alarcon Thompson N, 2012, Asociacion entre Escala de Alvarado y Diagnostico de Apendicitis Aguda Complicada y no Compli-Cada Segun Anatomia Patologica en el Centro Medico Naval (Association between Alvarado Scale and Diagnosis of Complicated and Uncomplicated Acute Appendicitis According to Anatomical Pathology at the Naval Medical Centre). Rev Horiz Med (Barcelona), 2012(12): 14–20.

Rebollar RC, Alvarez JG, Tellez RT, 2009, Apendicitis Aguda: Revision de la Literatura (Acute appendicitis: A review of the literature). Rev Hosp Jua Mex, 2009(76): 210–216.

Fallas J, 2012, Apendicitis Aguda (Acute Appendicitis). Med Leg Costa Rica, 2012(29): 83–90.

Aila MJ, Garcia-Acero M, 2015, Apendicitis Aguda: Revision de la Presentacion Histopatologica en Boyaca, Colombia (Acute Appendicitis: A review of Histopathological Presentation in Boyaca, Colombia). Rev Colomb Cir, 2015(30): 125–130.

Hernandez-Cortez J, De Leon-Rendon JL, Martinez-Luna MS, et al., 2019, Apendicitis aguda: Revision de la Literatura (Acute Appendicitis: A Review of the Literature). Cir Gen, 2019(41): 33–38.

Rodriguez-Fernandez Z, 2018, Consideraciones Vigentes en torno al Diagnostico de la Apendicitis Aguda (Current Considerations in the Diagnosis of Acute Appendicitis). Rev Cuba Cir, 2018(57): 55–71.

Rodriguez-Fernandez Z, 2009, Consideraciones Actuales Sobre el Diagnostico de la Apendicitis Aguda (Current Considerations in the Diagnosis of Acute Appendicitis). Rev Cuba Cir, 48: 1–9.

Calvo-Hernandez LD, 2012, Apendicitis Aguda en el Servicio de Urgencias (Acute Appendicitis in the Emergency Department). Rev Med Cos Cen, 2012(69): 281–285.

Udaquiola J, Arriaga V, Oesterreich R, et al., 2014, Apendicitis Aguda (Acute Appendicitis). Rev Pediatr Elizalde, 2014(5): 44–46.

Sanabria A, Dominguez LC, Vega V, et al., 2013, Tiempo de Evolucion de la Apendicitis y Riesgo de Perforacion (Time Course of Appendicitis and Risk of Perforation). Rev Colomb Cir, 2013(28): 24–30.

Fernandez MG, Costa Marsicano JM, 2018, Apendicitis Aguda y sus Complicaciones [Acute Appendicitis and its Complications]. Clin Quir Fac Med UdelaR, 2018: 1–7.

Souza-Gallardo LM, Martinez-Ordaz JL, 2017, Apendicitis Aguda. Manejo Quirurgico y no Quirurgico (Acute Appendicitis. Surgical and Non-surgical Management). Rev Med Inst Mex Seguro Soc, 2017(55): 76–81.

Sanchez-Echaniz J, Garcia L, Vazquez–Ronco MA, et al., 1998, Valor diagnostico de la Proteina C reactiva en las Sospechas de Apendicitis Aguda en la Infancia (Diagnostic Value of C-Reactive Protein in Suspected Acute Appendicitis in Childhood). An Esp Pediatr, 1998(48): 470–474.

Calvo-Rigual F, Sendra-Esteve S, Mialaret-Lahiguera A, 1998, Valor de la Proteina C-Reactiva en el Diagnostico de la Apendicitis Aguda en el Nino (Value of C-Reactive Protein in the Diagnosis of Acute Appendicitis in Children). An Esp Pediatr, 1998(48): 376–380.

Prada-Arias M, Salgado-Barreira A, Montero–Sanchez M, et al., 2018, Apendicitis Versus Dolor Abdominal Agudo Inespecifico: Evaluacion del Pediatric Appendicitis Score (Appendicitis Versus Non-Specific Acute Abdominal Pain: Evaluation of the Pediatric Appendicitis Score). An Pediatr, 2018(88): 32–38.

Neira-Sanchez ER, Malaga G, 2016, Sepsis-3 Y Las Nuevas Definiciones, es Tiempo de Abandonar SIRS? (Sepsis-3 and the New Definitions, is it Time to Abandon SIRS?) Acta Med Peru, 2016(33): 217–212.

Alvarado A, 1986, A Practical Score for the Early Diagnosis of Acute Appendicitis. Ann Emerg Med, 1986(15): 557–564.

Calvo-Rodriguez R, Gallardo-Valverde JM, Montero-Perez FJ, et al., 2016, Utilidad de los Biomarcadores en el Manejo del Dolor Abdominal (Utility of Biomarkers in Abdominal Pain Management). Rev Cient Soc Esp Med Urg Emerg, 2016(28): 185–192.

Canovas VN, Vera FM, Candia CR, et al., 2003, Proteina C Reactiva Como Predictor de Complicaciones Postoperatorias en Apendicitis Aguda (C–Reactive Protein as a Predictor of Postoperative Complications in Acute Appendicitis). Rev Chil Cir, 2003(55): 628–630.

Escalona PA, Bellolio RF, Dagnino UB, et al., 2006, Utilidad de la Proteina C Reactiva y RECUENTO de Leucocitos en Sospecha de Apendicitis Aguda (Usefulness of C-Reactive Protein and Leukocyte Count in Suspected Acute Appendicitis). Rev Chil Cir, 2006(58): 122–126.

De-Jonge J, Bolmers MDM, Musters GD, et al., 2019, Predictors for Interval Appendectomy in Non–Operatively Treated Complicated Appendicitis. Int J Colorectal Dis, 2019(34): 1325–1332.

Padierna-Luna JL, Ruiz-Valenzuela KL, Morales-Arellano AC, 2005, Proteina C Reactiva en el Diagnostico de Apendicitis Aguda (C-Reactive Protein in the Diagnosis of Acute Appendicitis). Rev Mex Patol Clin Med Lab, 2005(52): 163–167.

Aguirre GA, Falla A, Sanchez W, 2014, Correlacion de los Marcadores Inflamatorios (Proteina C Reactiva, Neutrofilia y Leucocitosis) en las Diferentes Fases de la Apendicitis Aguda [Correlation of Inflammatory Markers (C-Reactive Protein, Neutrophilia and Leukocytosis) in the Different Phases of Acute Appendicitis]. Rev Colomb Cir, 2014(29): 110–115.

Acharya A, Markar SR, Ni M, et al., 2017, Biomarkers of Acute Appendicitis: Systematic Review and Cost–Benefit Trade–Off Analysis. Surg Endosc, 2017(31): 1022–1031.

Guzman-Valdivia Gomez G, 2003, Una Clasificacion Util en Apendicitis Aguda (A Useful Classification in Acute Appendicitis). Rev Gastroenterol Mex, 2003(68): 261–265.

Martinez-Luna MS, Guzman-Ortiz JD, Ruschke-Sadot G, 2015, Uso de Proteina C Reactiva (PCR) Como Predictor de Complicaciones en Apendicitis Aguda (Use of C–Reactive Protein (CRP) as a Predictor of Complications in Acute Appendicitis). Rev Mex Cirug Apar Diges, 2015(4): 100–103.

Ishizuka M, Shimizu T, Kubota K, 2012, Neutrophil-to-Lymphocyte Ratio has a Close Association with Gangrenous Appendicitis in Patients Undergoing Appendectomy. Int Surg, 2012(97): 299–304.

Prasetya D, Rochadi, Gunadi, 2019, Accuracy of Neutrophil Lymphocyte Ratio for Diagnosis of Acute Appendicitis in Children: A Diagnostic Study. Ann Med Surg (Lond), 2019(48): 35–38.