Study on the Clinical Performance of Serum Hyponatremia in the Determination of Complicated Acute Appendicitis in the Adult Population at the General Hospital Zone No. 3, OOAD Aguascalientes

Abstract

Background: Appendicitis is the most common abdominal infection and is the main surgical emergency worldwide, affecting approximately 1 in 11 people during their lifetime. Nowadays, distinguishing between uncomplicated and complicated appendicitis is increasingly important due to the increasing evidence supporting the possibility of treating uncomplicated appendicitis with antibiotics instead of resorting directly to surgery. This differentiation requires combining clinical findings with laboratory and imaging studies. In our hospital setting, where the use of C-reactive protein, procalcitonin or imaging studies represent an increase in the costs of health services or are not routinely available, the use of prediction systems that include inexpensive and accessible serum markers could improve early identification and therefore prompt management in this group of patients. Objective: To identify the clinical performance of hyponatremia in patients undergoing open appendectomy with transoperative findings of complicated acute appendicitis in the adult population at the General Hospital of Zone No. 3, Aguascalientes, México. Material and methods: Retrospective, cross-sectional and instrumental study, at the General Hospital of Zone No. 3, part of the Mexican Social Security Institute (IMSS), Aguascalientes delegation. By reviewing the records of adult patients undergoing appendectomy with intraoperative findings of complicated acute appendicitis, in the period from February 1, 2023 to February 1, 2024, obtaining preoperative serum sodium values, seeking to identify the diagnostic accuracy of hyponatremia in the determination of complicated acute appendicitis. Results: There was a significant diagnostic performance with hyponatremia at its cut-off point of 133 mEq/L in the determination of complicated acute appendicitis. A sensitivity of 100%, specificity of 81.4%, NPV of 100%, PPV of 45.2%, LR+ of 2.16, LR- of 0.652 and a Youden index of 0.814 were determined. Conclusion: Hyponatremia can be useful in the diagnostic approach to acute appendicitis in hospitals with limited resources, guiding the surgical resolution of the condition, as well as the rapid establishment of a postoperative intravenous antibiotic regimen, reducing hospital expenses after limiting the morbidity generated by severe forms of this disease.