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Zhang Q, Zhang L, Wu J, Yang F. Effects of clinical nursing pathway on surgical site wound infection in patients undergoing acute appendicitis surgery: A meta-analysis. Int Wound J 2024; 21:e14600. [PMID: 38146201 PMCID: PMC10961861 DOI: 10.1111/iwj.14600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023] Open
Abstract
This study aimed to explore the impact of clinical nursing pathway applied to acute appendicitis surgery on patients' postoperative wound infections and complications. A computerised search of PubMed, Cochrane Library, Web of Science, EMBASE, Wanfang, Chinese Biomedical Literature Database and China National Knowledge Infrastructure was conducted and supplemented by a manual search, from database inception to October 2023, to collect randomised controlled trials (RCTs) on the application of clinical nursing pathways to acute appendicitis surgery. Literature screening, data extraction and quality assessment of the included literature were carried out independently by two researchers. RevMan 5.4 software was applied for data analysis. Twenty-one RCTs with a total of 2408 patients were finally included. The analysis revealed the implementation of clinical nursing pathway could effectively reduce the incidence of wound infection (OR = 0.26, 95% CI: 0.15-0.46, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15-0.27, p < 0.001), as well as shorten the hospital length of stay (MD = -3.26, 95% CI: -3.74 to -2.79, p < 0.001) and accelerated the time to first ventilations (MD = -14.85, 95% CI: -21.56 to -8.13, p < 0.001), as well as significantly improved patient satisfaction (OR = 5.52, 95% CI: 3.52-8.65, p < 0.001) in patients undergoing surgery for acute appendicitis. The application of clinical nursing pathway in acute appendicitis surgery can significantly reduce postoperative wound infection and complications, and at the same time can shorten the hospital length of stay as well as improve the satisfaction of patients.
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Affiliation(s)
- Qin Zhang
- Department of EmergencyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Li‐Hua Zhang
- Department of ObstetricsPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Jian‐Li Wu
- Department of OtolaryngologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Feng‐Yong Yang
- Department of EmergencyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
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Alfehaid MS, Babiker AM, Alkharraz AH, Alsaeed HY, Alzunaydi AA, Aldubaiyan AA, Sinyan HA, Alkhalaf BK, Alshuwaykan R, Khalil R, Al-Wutayd O. Elevated total and direct bilirubin are associated with acute complicated appendicitis: a single-center based study in Saudi Arabia. BMC Surg 2023; 23:342. [PMID: 37950198 PMCID: PMC10638704 DOI: 10.1186/s12893-023-02258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Appendicitis is the most common abdominal surgical emergency and up to our knowledge no previous studies have been conducted in Saudi Arabia particularly at Qassim region and this study aimed to determine a total and direct bilirubin as a predictor of acute complicated appendicitis. METHODS Observational retrospective study that included patients admitted under the general surgery department with a diagnosis of acute appendicitis at King Saud Hospital, Unaizah, Saudi Arabia. Data on age, gender, BMI, diabetes mellitus, total and direct bilirubin, AST, ALT, sodium, and WBCs levels were obtained. RESULT Among the overall study population of 158 patients, the age median [IQR] was 24.5 [19-31], males were 99 (62.7%), and complicated appendicitis was 33 (20.9%). The multivariable analysis revealed that both elevated total and direct bilirubin are associated with complicated appendicitis (aOR = 3.79, 95% CI: 1.67-8.48, P = 0.001) and (aOR = 4.74, 95% CI: 2.07-10.86, P < 0.001) respectively. A receiver operating characteristic curve showed the best cutoff value of total and direct bilirubin as ≥ 15 µmol/L and ≥ 5 µmol/L respectively, with a sensitivity of 57.6%, and specificity of 73.6% for elevated total bilirubin, and a sensitivity of 54.6%, and specificity of 80% for elevated direct bilirubin. CONCLUSION Elevated total and direct bilirubin are associated with acute complicated appendicitis in this setting. However, it should be supportive factor for acute complicated appendicitis and not considered as standalone diagnostic test.
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Affiliation(s)
- Mohammed S Alfehaid
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Ayman M Babiker
- King Saud Hospital, Ministry of Health, Unaizah, Saudi Arabia
| | - Abdullah Hamad Alkharraz
- Research unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Hamad Yousef Alsaeed
- Research unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Ali Abdullah Alzunaydi
- Research unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Adi Abdulaziz Aldubaiyan
- Research unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | | | | | | | - Rehana Khalil
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Osama Al-Wutayd
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia.
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Strohäker J, Brüschke M, Feng YS, Beltzer C, Königsrainer A, Ladurner R. Predicting complicated appendicitis is possible without the use of sectional imaging-presenting the NoCtApp score. Int J Colorectal Dis 2023; 38:218. [PMID: 37597055 PMCID: PMC10439846 DOI: 10.1007/s00384-023-04501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Appendicitis is among the most common acute conditions treated by general surgery. While uncomplicated appendicitis (UA) can be treated delayed or even non-operatively, complicated appendicitis (CA) is a serious condition with possible long-term morbidity that should be managed with urgent appendectomy. Distinguishing both conditions is usually done with computed tomography. The goal of this study was to develop a model to reliably predict CA with widespread available clinical and laboratory parameters and without the use of sectional imaging. METHODS Data from 1132 consecutive patients treated for appendicitis between 2014 and 2021 at a tertiary care hospital were used for analyses. Based on year of treatment, the data was divided into training (n = 696) and validation (n = 436) samples. Using the development sample, candidate predictors for CA-patient age, gender, body mass index (BMI), American Society of Anesthesiologist (ASA) score, duration of symptoms, white blood count (WBC), total bilirubin and C-reactive protein (CRP) on admission and free fluid on ultrasound-were first investigated using univariate logistic regression models and then included in a multivariate model. The final development model was tested on the validation sample. RESULTS In the univariate analysis age, BMI, ASA score, symptom duration, WBC, bilirubin, CRP, and free fluid each were statistically significant predictors of CA (each p < 0.001) while gender was not (p = 0.199). In the multivariate analysis BMI and bilirubin were not predictive and therefore not included in the final development model which was built from 696 patients. The final development model was significant (x2 = 304.075, p < 0.001) with a sensitivity of 61.7% and a specificity of 92.1%. The positive predictive value (PPV) was 80.4% with a negative predictive value (NPV) of 82.0%. The receiver operator characteristic of the final model had an area under the curve of 0.861 (95% confidence interval 0.830-0.891, p < 0.001. We simplified this model to create the NoCtApp score. Patients with a point value of ≤ 2 had a NPV 95.8% for correctly ruling out CA. CONCLUSIONS Correctly identifying CA is helpful for optimizing patient treatment when they are diagnosed with appendicitis. Our logistic regression model can aid in correctly distinguishing UA and CA even without utilizing computed tomography.
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Affiliation(s)
- Jens Strohäker
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
| | - Martin Brüschke
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - You-Shan Feng
- Department of Epidemiology and Biostatistics, University Hospital of Tuebingen, Tuebingen, Germany
| | | | - Alfred Königsrainer
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Ruth Ladurner
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
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Wu Z, Zhao L, Feng S, Luo J. Hyperfibrinogenemia and hyponatremia as predictors of perforated appendicitis in children: A retrospective cohort study. Int J Colorectal Dis 2023; 38:72. [PMID: 36930335 DOI: 10.1007/s00384-023-04362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The aim of this study was to investigate the predictive value of hyperfibrinogenemia and hyponatremia for perforated appendicitis in children. METHODS A retrospective review of 521 pediatric patients (≤ 15 years) with acute appendicitis confirmed by histopathology from January 2017 to December 2020 was performed. Patients were divided in two groups, those with non-perforated (n = 379; 73%) and perforated appendicitis (n = 142; 27%). The serum values of sodium and fibrinogen were taken before surgery. We performed the receiver operating characteristic analysis for the two biochemical markers. The sensitivity, specificity, positive and negative predictive values for perforated appendicitis in the presence of hyponatremia and hyperfibrinogenemia were calculated. RESULTS Hyperfibrinogenemia (≥ 4.0 g/L) was found in 58.45% of perforated appendicitis and 104 of 142 (73.34%) children with perforated appendicitis had hyponatremia (≤ 135 mmol/L). The perforated appendicitis group had a higher mean fibrinogen concentration (P = 0.001). There was a statistically significant difference in mean serum sodium levels between the perforated appendicitis and non-perforated appendicitis groups (P = 0.016). Receiver operating characteristic curve analysis for fibrinogen, sodium and combination of the both markers shown the combination had the largest area under the curve in identifying children with perforated acute appendicitis (0.858) (95% CI, 0.82-0.90) compared with fibrinogen (0.815) (95% CI, 0.77-0.86) and sodium 0.818 (95% CI, 0.78-0.86) alone. Furthermore, the combination of both markers had the best positive and negative predictive value for appendix perforation compared to fibrinogen and sodium. CONCLUSION Hyponatremia and/or hyperfibrinogenemia are excellent markers for predicting perforated appendicitis in children. We propose that plasma sodium and/or fibrinogen concentrations be utilized as a supplementary to guide individual treatment decisions in children with appendicitis, such as surgery timing and nonoperative management options.
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Affiliation(s)
- Zhenfei Wu
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Lingling Zhao
- Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University, (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Jinjian Luo
- Department of Pulmonary and Critical Care Medicine (PCCM), Anji Branch of the First Affiliated Hospital of Zhejiang University, Anji County People's Hospital, Huzhou, Zhejiang, 313300, China.
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Hyperbilirubinemia and Hyponatremia as Predictors of Complicated Appendicitis. Med Sci (Basel) 2022; 10:medsci10030036. [PMID: 35893118 PMCID: PMC9326721 DOI: 10.3390/medsci10030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Several studies have reported elevated serum bilirubin or reduced serum sodium levels in patients with complicated appendicitis (CA). This study examined the efficacy of hyperbilirubinemia, hyponatremia, and both combined in the preoperative diagnosis of CA. Patients who underwent surgery for acute appendicitis were included in this retrospective review. In total, 247 patients were included in the final analysis. Of these, 36 (14.2%) had early appendicitis, 177 (72.0%) had acute suppurative appendicitis, 32 (13.0%) had necrotizing/gangrenous acute appendicitis, and 2 (0.8%) had other types of appendicitis. The mean total bilirubin (TBIL) level was significantly higher in patients with CA than in those with uncomplicated appendicitis. Conversely, the mean serum sodium level was significantly lower in patients with CA than in those with uncomplicated appendicitis. The levels of TBIL (odds ratio: 1.098, 95% CI: 1.052–1.147) and serum sodium (odds ratio: 0.743, 95% CI: 0.646–0.855) were associated with CA. Hyponatremia combined with hyperbilirubinemia yielded significant discriminatory value for the diagnosis of CA. TBIL and serum sodium levels can be considered as adjuvant parameters in the diagnosis of perforated/necrotizing appendicitis. Although hyperbilirubinemia and hyponatremia together were better able to determine the risk of CA than either marker alone, other markers are required to definitively predict CA. Furthermore, large-scale studies are needed to confirm these findings.
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The Clinical Significance of Shock Index and GFR in the Differential Diagnosis of Perforated Appendicitis. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1090115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rajalingam VR, Mustafa A, Ayeni A, Mahmood F, Shammout S, Singhal S, Akingboye A. The Role of Neutrophil-Lymphocyte-Ratio (NLR) and Platelet-Lymphocyte-Ratio (PLR) as a Biomarker for Distinguishing Between Complicated and Uncomplicated Appendicitis. Cureus 2022; 14:e21446. [PMID: 35223231 PMCID: PMC8857869 DOI: 10.7759/cureus.21446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction Acute appendicitis (AA) is one of the most common acute general surgical presentations affecting 7% of the population at some point in their lifetime. The ability to assess the risk of complicated appendicitis (CA) from uncomplicated appendicitis (UA) in acute appendicitis (AA) could reduce the associated morbidity and mortality. The value of platelet lymphocyte ratio (PLR) as an inflammatory marker increases when its fluctuations are interpreted along with other complementary hematologic indices, such as neutrophil-to-lymphocyte ratio (NLR), which provides additional information about the disease activity. Hence, we postulated that NLR and/or PLR could serve as a potential surrogate marker in assessing the severity of AA. Aim This study aims to investigate the use of PLR and/or NLR as a surrogate biomarker in differentiating uncomplicated from complicated appendicitis. Material and methods This retrospective study was conducted at Russells Hall Hospital from January 1, 2017, to December 31, 2020. Data of all patients over age 16 years that had histologically confirmed appendicitis were retrieved. NLR and PLR were calculated from the admission hemogram, and the ratios were compared between uncomplicated (UA) or complicated appendicitis (CA). Cut-off values were calculated using the summarized ROC curve; in addition, the sensitivity and specificity with 95% confidence intervals were determined using SPSS 25.0 (IBM Corp., Armonk, NY). Results A total of 799 patients were analyzed, of which 469 (58.7%) were female. The median age was 31.2 years. The difference between NLR and PLR within the two appendicitis groups was significant (P=0.05; Kruskal-Wallis). Cohen’s kappa (degree of inter-rater agreement) between NLR and PLR showed a moderate agreement of 0.589 (P<0.001). We equally demonstrated an exponential relationship between PLR and NLR (R2 =0.510, P<0.05). For UA, the area under the curve (AUC) and the cut-off for NLR and PLR were 0.715, 4.75 with a confidence interval (CI) of 0.678-0.653 and 0.632, 155 with a CI of 0.591-0.672, respectively. For CA, using NLR and PLR, the AUC and cut-off were 0.727, 6.96 with a CI of 0.687-0.768 and 0.653, 180.5 with a CI of 0.602-0.703, respectively; all were significant with a P of <0.001. Conclusion NLR and PLR are a reliable, less cumbersome surrogate biomarker for assessing the severity of acute appendicitis.
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Zosimas D, Lykoudis PM, Strano G, Burke J, Al-Cerhan E, Shatkar V. Bilirubin is a specific marker for the diagnosis of acute appendicitis. Exp Ther Med 2021; 22:1056. [PMID: 34434270 DOI: 10.3892/etm.2021.10490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/19/2021] [Indexed: 11/05/2022] Open
Abstract
Total serum bilirubin and other biochemical parameters have been associated with acute appendicitis, mainly in complicated cases. The present study aimed to evaluate the role of biochemical parameters in the diagnosis of acute appendicitis, and to further investigate the role of bilirubin as a diagnostic marker irrespective of the severity of the pathology. All recorded cases of appendicectomies in a 1-year period in a single institution were reviewed. The median values of white cell count, C-reactive protein and total serum bilirubin on admission were associated with final histology, and their respective rates of abnormal and normal values were compared between patients who were proven to have negative histology and patients who were proven to have acute appendicitis. A total of 300 patients were studied. Median total serum bilirubin, white cell count and C-reactive protein on admission were significantly associated with acute appendicitis (P<0.001). Respective rates of normal and abnormal values were significantly associated with final histology (P<0.001). Total serum bilirubin demonstrated higher specificity (0.88) but lower sensitivity (0.26) and diagnostic accuracy (0.40) for acute appendicitis. In conclusion, total serum bilirubin on admission should be considered in the diagnostic workup to confirm rather than exclude appendicitis, without focusing on subgroups of specific severity of the disease. White cell count and C-reactive protein may also contribute to the diagnostic work-up, although with limited accuracy.
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Affiliation(s)
- Dimitrios Zosimas
- Department of General Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
| | - Panagis M Lykoudis
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, UK
| | - Giuseppe Strano
- Department of General Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
| | - Josh Burke
- Department of General Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
| | - Eyad Al-Cerhan
- Department of General Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
| | - Veeranna Shatkar
- Department of General Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
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Hodge SV, Mickiewicz B, Lau M, Jenne CN, Thompson GC. Novel molecular biomarkers and diagnosis of acute appendicitis in children. Biomark Med 2021; 15:1055-1065. [PMID: 34284638 DOI: 10.2217/bmm-2021-0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Reliable and efficient diagnosis of pediatric appendicitis is essential for the establishment of a clinical management plan and improvement of patient outcomes. Current strategies used to diagnose a child presenting with a suspected appendicitis include laboratory studies, clinical scores and diagnostic imaging. Although these modalities work in conjunction with each other, one optimal diagnostic strategy has yet to be agreed upon. The recent introduction of precision medicine techniques such as genomics, transcriptomics, proteomics and metabolomics has increased both the diagnostic sensitivity and specificity of appendicitis. Using these novel strategies, the integration of precision medicine into clinical practice via point-of-care technologies is a plausible future. These technologies would assist in the screening, diagnosis and prognosis of pediatric appendicitis.
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Affiliation(s)
- Sarah Vl Hodge
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Beata Mickiewicz
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Matthew Lau
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Craig N Jenne
- Department of Microbiology, Immunology & Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Graham C Thompson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.,Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Abstract
Introduction Very different results have been reported regarding the relationship between bilirubin and perforated appendicitis. We observed this relationship with our own studies. Methods The patients, who underwent appendectomy, were retrospectively categorized as perforated and non-perforated based on their files. Those with a total bilirubin (TB) 1.20 mg/dL or less were considered normal whereas those with a 1.21 mg/dL or higher were considered having a high. Those with a direct bilirubin (DB) 0.50 mg/dL or less were considered normal whereas those with a 0.51 mg/dL or higher were considered having a high. The patients were assessed under two groups. Perforated appendicitis (PA) and non-perforated appendicitis (NPA) were analyzed according to the TB in Group 1 and the DB in Group 2. Results Group 1 included 269 patients whose TB were measured. Of those, 218 had NPA and 51 had PA. The rate of patients with high TB among the patients with PA was 1.37 times higher than those with NPA (p ˂ 0.01). Group 2 included 258 patients whose DB values were measured. Of those, 208 had NPA and 50 had PA. The rate of patients with high TB among the patients with PA was 1.71 times higher than those with NPA (p ˂ 0.001). Conclusion In the diagnosis of PA, both TB and DB show low diagnostic values. In the diagnosis, they can only be considered as a supportive factor to other parameters. However, in the case of a differential diagnosis, we recommend using DB since it has a higher sensitivity and specificity.
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Affiliation(s)
- Murat Kanlioz
- General Surgery, Beylikdüzü Kolan Hospital, Istanbul, TUR
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11
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Relationship between appendicitis and diameter of ileocecal lipomatosis and also ileocecal angle. Surg Radiol Anat 2019; 42:437-441. [PMID: 31781922 DOI: 10.1007/s00276-019-02392-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE One of the most widespread surgical conditions is acute appendicitis in industrialized countries. Nevertheless, diagnosis of borderline cases is mostly troublesome and needs subsequent researches. For this reason, we aimed to investigate new parameters to improve estimation of acute appendicitis. Lymphoid hyperplasia, impacted stool, faecolith, caecal or appendiceal tumors have been accepted as causes of appendicitis formation, but anatomic variations of diameter of ileocecal lipomatosis and ileocecal angle have been never discussed before. The aim of this study was to assess the relationship between appendicitis and diameter of ileocecal lipomatosis and ileocecal angle. MATERIALS AND METHODS 96 Patients (51 women, 45 men) who were found to have acute appendicitis during exploration and 67 patients (32 women, 35 men) who were not pre-diagnosed with acute appendicitis were enrolled in the study. The diameter of ileocecal lipomatosis and also ileocecal angle values were obtained via computed tomography (CT) scans. RESULTS There were no significant differences between two groups in the mean of ileocecal angle (p > 0.05) but diameter of ileocecal lipomatosis values was significantly higher in the appendicitis-positive group compared with the appendicitis-negative group (p: 0.001). CONCLUSIONS There is a relationship between increase in diameter of ileocecal lipomatosis and appendicitis formation.
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Comparison of Outer Diameter of Appendix, C-reactive Protein, and Serum Bilirubin Levels in Complicated Versus Uncomplicated Appendicitis. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01931-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis. Am J Surg 2019; 219:154-163. [PMID: 31056211 DOI: 10.1016/j.amjsurg.2019.04.018] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/31/2019] [Accepted: 04/19/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES to investigate whether Neutrophil-to-lymphocyte ratio (NLR) can predict acute appendicitis and whether it can distinguish between uncomplicated and complicated appendicitis. METHODS A search of electronic information sources was conducted to identify all studies reporting NLR in patients with clinical suspicion or confirmed diagnosis of acute appendicitis. We considered two comparisons:1) appendicitis versus no appendicitis; 2) uncomplicated appendicitis versus complicated appendicitis. ROC curve analysis was performed to determine cut-off values of NLR for appendicitis and complicated appendicitis. RESULTS Seventeen studies, enrolling 8,914 patients were included. NLR of 4.7 was cut-off value for appendicitis with sensitivity of 88.89% and specificity of 90.91% with AUC of 0.96. NLR of 8.8 was cut-off value for complicated appendicitis with sensitivity of 76.92% and specificity 100% with AUC of 0.91. NLR >4.7 was predictor of acute appendicitis (OR:128,P < 0.0001) and, NLR >8.8 was predictor of complicated appendicitis (OR:43,P < 0.0001). CONCLUSIONS NLR predicts both diagnosis and severity of appendicitis. This may have implications for prioritising cases for surgery, for monitoring conservatively treated patients and for patients who do not routinely undergo CT scan (pregnant or paediatric patients).
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, North Manchester General Hospital, Northern Care Alliance NHS Group, Manchester, UK.
| | - Shahin Hajibandeh
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Nicholas Hobbs
- Department of General Surgery, North Manchester General Hospital, Northern Care Alliance NHS Group, Manchester, UK
| | - Moustafa Mansour
- Department of General Surgery, North Manchester General Hospital, Northern Care Alliance NHS Group, Manchester, UK
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Shin DH, Cho YS, Kim YS, Ahn HC, Oh YT, Park SO, Won MH, Cho JH, Kim YM, Seo JY, Lee YH. Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non-perforated appendicitis in the elderly. J Clin Lab Anal 2017; 32. [PMID: 28238210 DOI: 10.1002/jcla.22177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 01/19/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Delta neutrophil index (DNI) is a new inflammatory marker and the present study aimed to evaluate the predictive value of the DNI for the presence of a perforation in elderly with acute appendicitis. METHODS This retrospective observational study was conducted on 108 consecutive elderly patients (≥65 years old) with acute appendicitis treated over a 24-month period. RESULTS Sixty-nine of the 108 patients (median, IQR: 72, 67-77 years) were allocated to the perforated appendicitis group (63.9%) and 39 to the non-perforated appendicitis group (36.1%). WBC, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and DNI were significantly higher in the perforated group. In multiple logistic regression analyses, initial DNI was the only independent marker that can significantly predict the presence of perforation in multiple regression [odds ratio 9.38, 95% confidence interval (2.51-35.00), P=.001]. Receiver operator characteristic curve analysis showed that DNI is a good predictor for the presence of appendiceal perforation at an optimal cut-off for DNI being 1.4% (sensitivity 67.7%, specificity 90.0%, AUC 0.807). CONCLUSION Clinicians can reliably differentiate acute perforated appendicitis from non-perforated appendicitis by DNI level of 1.4 or more in elderly patients.
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Affiliation(s)
- Dong Hyuk Shin
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Suk Cho
- Department of Emergency Medicine, School of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, Korea
| | | | - Hee Cheol Ahn
- Department of Emergency Medicine, Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Young Taeck Oh
- Department of Emergency Medicine, Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea.,Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea
| | - Sang O Park
- Department of Emergency Medicine, School of Medicine, Konkuk University Konkuk University Medical Center, Seoul, Korea
| | - Moo-Ho Won
- Department of Neurobiology, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea
| | - Jun Hwi Cho
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea
| | - Young Myeong Kim
- Department of Molecular and Cellular Biochemistry, College of Medicine, Kangwon National University, Chunchon, Korea
| | - Jeong Yeol Seo
- Department of Emergency Medicine, School of Medcine, Hallym University, Chunchon, Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea.,Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea
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15
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Scholz P, Lenoir U, Borbély Y. Letter to the Editor regarding Adams HL, Jaunoo SS. Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation. Eur J Trauma Emerg Surg. 2016; 42:249-52. Eur J Trauma Emerg Surg 2016; 42:529. [PMID: 27334387 DOI: 10.1007/s00068-016-0699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/16/2016] [Indexed: 11/25/2022]
Affiliation(s)
- P Scholz
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - U Lenoir
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Y Borbély
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
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16
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Kim M, Kim SJ, Cho HJ. International normalized ratio and serum C-reactive protein are feasible markers to predict complicated appendicitis. World J Emerg Surg 2016; 11:31. [PMID: 27330547 PMCID: PMC4915056 DOI: 10.1186/s13017-016-0081-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/25/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diagnostic approach for complicated appendicitis is still controversial. We planned this study to analyze preoperative laboratory markers that may predict complications of appendicitis. METHODS Patients who underwent appendectomy were retrospectively recruited. They were divided into complicated appendicitis and non-complicated appendicitis groups and their preoperative laboratory results were reviewed. RESULTS A total of 234 patients were included. Elevated international normalized ratio (INR) and serum C-reactive protein (CRP) were associated with complicated appendicitis (p = 0.001). On ROC curve analysis, area under the curve (AUC) of CRP and INR were 0.796 and 0.723, respectively. CONCLUSIONS INR and CRP increased significantly in patients with complicated appendicitis. Further studies evaluating INR and CRP in patients undergoing conservative management for appendicitis are required.
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Affiliation(s)
- Maru Kim
- Department of Trauma Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Jeep Kim
- Department of Trauma Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hang Joo Cho
- Department of Trauma Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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17
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Gandy RC, Wang F. Should the non-operative management of appendicitis be the new standard of care? ANZ J Surg 2016; 86:228-31. [PMID: 26991357 DOI: 10.1111/ans.13506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/02/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Robert C. Gandy
- Department of Surgery, Prince of Wales Hospital; Sydney New South Wales Australia
- Prince of Wales Clinical School, The University of New South Wales; Sydney New South Wales Australia
| | - Frank Wang
- Department of Surgery, Campbelltown Hospital; Campbelltown New South Wales Australia
- Academic Division of Surgery, Western Sydney University; Sydney New South Wales Australia
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18
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Hyperbilirubinemia as a predictive factor in acute appendicitis. Eur J Trauma Emerg Surg 2015; 42:471-476. [PMID: 26253886 DOI: 10.1007/s00068-015-0562-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/31/2015] [Indexed: 11/26/2022]
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