Predictors Of Complicated Appendicitis Research Articles

Use of Different Haematological Parameter as a Predictor of Complicated Appendicitis

Use of Different Haematological Parameter as a Predictor of Complicated Appendicitis

Effect of in-hospital delay on acute appendicitis severity: does time really matter?

Appendicitis is one of the most common abdominal emergencies. Evidence is controversial in determining if the in-hospital time delay to surgery can worsen the clinical presentation of appendicitis. This study aimed to clarify if in-hospital surgical delay significantly affected the proportion of complicated appendicitis in a large prospective cohort of patients treated with appendectomy for acute appendicitis. Patients were grouped into low, medium, and high preoperative risk for acute appendicitis based on the Alvarado scoring system. Appendicitis was defined as complicated in cases of perforation, abscess, or diffuse peritonitis. The primary outcome was correlation of in-hospital delay with the proportion of complicated appendicitis. The study includes 804 patients: 278 (30.4%) had complicated appendicitis and median time delay to surgery in low-, medium-, and high-risk group was 23.15h (13.51-31.48), 18.47h (10.44-29.42), and 13.04 (8.13-24.10)h, respectively. In-hospital delay was not associated with the severity of appendicitis or with the presence of postoperative complications. It appears reasonably safe to delay appendicectomy for acute appendicitis up to 24h from hospital admission. Duration of symptoms was a predictor of complicated appendicitis and morbidity. Timing for appendicectomy in acute appendicitis should be calculated from symptoms onset rather than hospital presentation.

The role of high serum bilirubin as a predictor of complicated appendicitis: a retrospective cohort study

Introduction: An appendectomy is one of the most common emergency surgeries. The delay in diagnosis and treatment of appendicitis can lead to complicated appendicitis. The definitive predictive factor that can diagnose complicated appendicitis is still lacking. The authors aim to assess the role of high serum bilirubin level as a predictor of complicated appendicitis. Methods: A retrospective cohort study was conducted among patients with acute appendicitis (AA) between March 2017 and March 2018. Appendicitis cases diagnosed with the help of the Alvarado score undergoing surgery were taken in study and based on the histopathological report, the cases were classified into two groups: uncomplicated and complicated. Preoperatively, biochemical parameters like increased white blood cell count (>11000/cubic millimeter), and level of serum bilirubin >1.4 mg/dl were studied. Informed written consent for the study was taken from the patients with AA. A χ 2 test was applied for the association between categorical variables. Statistical analysis was done with a statistical package for the social sciences (SPSS) version 20; P-value less than 0.05 was considered statistically significant. Results: A total of 100 patients were enrolled in the study with a mean age of 31.2±18.3 years, and 60% were male. Seventy-four (74%) had uncomplicated appendicitis and 26 (26%) had complicated appendicitis. Mean bilirubin was 1.2±0.8 mg/dl in uncomplicated and 1.8±0.8 mg/dl in complicated groups (P <0.05). The sensitivity and specificity of hyperbilirubinemia as a predictor of complicated appendicitis were 50 and 78.38%, respectively. Conclusion: The study revealed that patients with AA and a higher serum bilirubin level have a higher risk of having complicated appendicitis. Serum bilirubin level helps to predict complicated appendicitis and thus plan for timely and appropriate management. Thus, the study concludes that bilirubin should be used together with clinical examination and other laboratory investigations in the assessment of patients with suspected AA.

Blood cell indices as predictors of complicated appendicitis: A diagnostic study

BackgroundAppendicitis in children is associated with diagnostic complexity leading to delayed diagnosis. Such delays risk progression to complicated appendicitis. This study investigates the potential of cellular indices, including neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), to differentiate uncomplicated (UA) from complicated appendicitis (CA). MethodsDiagnostic study of pediatric patients with acute appendicitis admitted to our hospital from 2021 to 2022. NLR, dNLR, PLR and MLR were compared between groups. ResultsA total of 182 patients were enrolled: 116 cases with CA (63 % male, age 9.6 ± 5.5 years) and 66 patients with UA (67 % male, age 10.6 ± 2.7 years). All blood cell indices were significantly higher in the CA group than in the UA group (p= <0.0001). NLR, dNLR and PLR have a good area under the receiver operating characteristic (ROC) curve, whereas MLR has a regular curve (0.735). PLR was the most accurate predictor of CA with a sensitivity of 60 %, specificity of 85 %, positive predictive value of 88 %, area under the ROC curve of 0.802 (95 % CI 0.737–0.866) and a cut-off point for the diagnosis of CA of 213.3. The post-test probability of CA for a positive result on PLR was 80 % (95 % CI 69–88). ConclusionsPLR seems to be the most accurate cellular index to differentiate uncomplicated from complicated appendicitis in children. It may be useful for prioritizing cases for surgery as a predictor of intraoperative findings and early postoperative courses.

Evaluation of systemic immune-inflammation index efficacy in predicting complicated appendicitis in pediatric emergency department.

Acute appendicitis (AA) is one of the most important causes of acute abdominal pain in children who are admitted to the pediatric emergency department. This study aims to determine the usefulness of the systemic immune-inflammation index (SII) in predicting complicated appendicitis (CA) in pediatric patients. The patients who underwent surgery with the diagnosis of AA were evaluated retrospectively. AA and control groups were formed. AA was divided into noncomplicated and CA groups. C-reactive protein (CRP), white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count, neutrophil/lymphocyte ratio (NLR), platelet (PLT)/lymphocyte ratio (PLR), and SII values were recorded. The SII was calculated with the formula of PLT count × neutrophil/lymphocyte. The efficacy of biomarkers in predicting CA was compared. Our study included 1072 AA and 541 control patients. There were 74.3% of patients in the non-CA (NCA) group and 25.7% in the CA group. CRP, WBC count, ANC, NLR, PLR when AA and control group, complicated and NCA groups are compared in terms of laboratory parameters and SII level AA and it was higher in the CA group. While the SII value was 2164.91±1831.24 in the patients with NCA and 3132.59±2658.73 in those with CA (P<0.001). When the cut-off values were determined according to the area under the curve, CRP and SII were found to be the best biomarkers in predicting CA. Inflammation markers together with clinical evaluation may be useful in distinguishing noncomplicated and complicated AA. However, these parameters alone are not sufficient to predict CA. CRP and SII are the best predictors of CA in pediatric patients.

Using neutrophil-lymphocyte ratio, mean platelet volume, and hyponatremia to diagnose appendicitis in children

Background: Acute appendicitis is one of the common reasons for acute abdominal pain among children. The diagnosis of appendicitis in children is always challenging. There is a failure to improve morbidity and mortality related to appendicitis, even after advancements in imaging modalities. Therefore, there is a need for markers to help in the diagnosis process. This study aimed at finding if neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), and hyponatremia are helpful tools to diagnose acute appendicitis and whether they can be beneficial in distinguishing complicated from uncomplicated appendicitis among children. Methods: This cross-sectional study was conducted on the pediatric population who were diagnosed with acute appendicitis and treated as an inpatient in the Ministry of Health Hospitals in Abha and Khamis Mushayt. The data of patients were collected using a data collection sheet. Statistical analysis was conducted using the Statistical Package for the Social Sciences software. Results: Among 384 children with appendicitis; 72.9% had an uncomplicated acute appendectomy, and 27.1% had a complicated condition. NLR significantly increased among complicated cases (p &amp;lt; 0.001), whereas MPV and sodium levels were increased among uncomplicated patients (p &amp;lt; 0.001). The logistic regression model showed that NLR was a predictor for complicated appendicitis (p = 0.031, OR = 1.066; CI 1.006-1.129), whereas regarding increased levels of MPV and sodium, it was found that p = 0.009, OR = 0.794; CI 0.668-0.945 for MPV, and p &amp;lt; 0.001, OR = 0.803; CI 0.735-0.878 for sodium. Conclusion: NLR, low MPV, and hyponatremia have a role in the diagnosis of complicated appendicitis, and they can be predictors of complicated appendicitis.

Predictors of Complicated Appendicitis with Evolution to Appendicular Peritonitis in Pediatric Patients.

Background and Objecitves: Appendicitis is one of the most frequent surgical emergencies in pediatric surgery. Complicated appendicitis can evolve with appendicular peritonitis characterized by the diffusion of the pathological process to the peritoneal cavity, thus producing generalized or localized inflammation of the peritoneum. The capacity to anticipate the possibility of perforation in acute appendicitis can direct prompt management and lower morbidity. There is no specific symptom that could be used to anticipate complicated appendicitis, and diagnostic clues include a longer period of symptoms, diffuse peritoneal signs, high fever, elevated leukocytosis and CRP, hyponatremia, and high ESR. Imagistic methods, particularly US and CT, are useful but not sufficient. There are no traditional inflammation biomarkers able to predict the evolution of uncomplicated to complicated appendicitis alone, but the predictive capacity of novel biomarkers is being investigated. Materials and Methods: The present study represents a retrospective evaluation of children hospitalized between January 2021 and July 2022 in the Grigore Alexandrescu Clinical Emergency Hospital for Children with a diagnosis of acute appendicitis settled based on clinical characteristics, traditional and novel biomarkers, and ultrasonographic features. The children were subsequently grouped into two groups based on the existence of appendicular peritonitis on intraoperative inspection of the abdominal cavity. The aim of this report is to establish the predictors that may aid physicians in timely identifying pediatric patients diagnosed with acute appendicitis at risk for developing complicated appendicitis with evolution to appendicular peritonitis. Results: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte radio (PLR) are representative severity markers in infections. This report analyzes the benefit of these markers for distinguishing uncomplicated appendicitis from complicated appendicitis in pediatric patients. Conclusions: Our study suggests that a value of neutrophil-to-lymphocyte ratio greater than 8.39 is a reliable parameter to predict the evolution to appendicular peritonitis.

Single-Center Retrospective Analysis of Neutrophil, Monocyte, and Platelet to Lymphocyte Ratios as Predictors of Complicated Appendicitis.

AimWe look at the ability of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) to differentiate between uncomplicated and complicated appendicitis.Methods and materialsThis was a retrospective, single-center study of 234 individuals diagnosed with acute appendicitis between January 1, 2020, and December 31, 2020. Patients were grouped into uncomplicated and complicated appendicitis subgroups. Patients with histologically or radiologically proven gangrenous or perforated appendicitis, as well as those with peritonitis or peri-appendiceal abscess development, comprise the complicated subgroup. Independent Mann-Whitney samples The U test was used to predict lab values of complicated appendicitis. Furthermore, the receiver operating characteristic (ROC) curve and area under the curve (AUC) were utilized to predict the sensitivity and specificity of laboratory results reported to have a significant connection with complex appendicitisResultsThe criteria were met by 186 patients, with a male-to-female proportion of 1.06:1, an average age of 36.4 years, and an average stay of 2.73 days. There were 95 individuals with complicated appendicitis. With 66.3%, perforated appendicitis was the most prevalent condition. The ratios of neutrophils to lymphocytes, monocytes to lymphocytes, and platelets to lymphocytes were linked with complicated appendicitis with a p-value of < 0.0001, and p-values = 0.015, and 0.015, respectively.ConclusionNLR, MLR, and PLR are valid, less onerous surrogate biomarkers for measuring the severity of acute complicated appendicitis and differentiating it from uncomplicated appendicitis.

Bilirubin as a Predictor of Complicated Appendicitis in a District General Hospital: A Retrospective Analysis.

AimsThe objectives of the study were to establish the function of bilirubin as a novel diagnostic tool for predicting complex appendicitis and to compare the impact of other variables such as white blood cell count (WCC), C-reactive protein (CRP), and neutrophil.MethodsThis retrospective, single-center cohort analysis included all patients admitted to Torbay General Hospital in Torquay, United Kingdom, between January 2020 and December 2020 with a clinical diagnosis of acute appendicitis. In addition to serum CRP, WCC, and neutrophil, serum bilirubin and other liver enzymes were obtained from the patients’ blood on admission.ResultsThe quantitative analysis included 174 patients from the group that remained. The large majority of the sample consisted of adults and males (77% and 51.7%, respectively). Overall, 49.4% of participants in the study were diagnosed with complicated appendicitis; 74.7% of adults had complicated appendicitis, with 58.6% being male. In 68.6% of cases, perforated appendicitis was the most prevalent form of complicated appendicitis. Patients with complicated appendicitis had significantly higher WCC, neutrophil, and CRP levels than those with uncomplicated appendicitis (14.15 vs. 12.88, p = 0.016; 11.63 vs. 10.19, p = 0.007; and (89.28 vs. 40.65, p = 0.0001, respectively).. The significantly greater alkaline phosphatase and total serum bilirubin discrepancies were observed in patients with complicated appendicitis. There were statistically significant differences in the means of the patients: (18.46 vs. 10.98, p = 0.0001 and 110.64 vs. 102.24, p = 0.033).ConclusionSerum bilirubin is a crucial diagnostic aid for determining the existence of complicated appendicitis.

Hyperbilirubinemia and Hyponatremia as Predictors of Complicated Appendicitis.

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.

Development and Validation of a Clinical Prediction Model for Complicated Appendicitis in the Elderly.

BackgroundFor elderly patients with mild clinical symptoms of uncomplicated appendicitis(UA), non-surgical treatment has been shown to be feasible, whereas emergency surgical treatment is recommended in elderly patients with complicated appendicitis(CA), but it is still challenging to accurately distinguish CA and UA before treatment. This study aimed to develop a predictive model to assist clinicians to quickly determine the type of acute appendicitis.MethodsWe retrospectively studied the clinical data of elderly patients with acute appendicitis who visited the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2012 to January 2022. The patients were divided into UA group and CA group, and the general conditions, medical history, physical examination, laboratory examination and imaging examination were compared between the two groups, and SPSS 26.0 and R 4.0.2 software were used to establish CA clinic. Predict the model, and validate it internally.ResultsThe clinical data of 441 elderly patients with acute appendicitis were collected, 119 patients were excluded due to incomplete clinical data or other diseases. Finally, 332 patients were included in the study and divided into UA group (n = 229) and CA group (n = 103). By analyzing the clinical data of the two groups of patients, the duration of abdominal pain [OR = 1.094, 95% CI (1.056–1.134)], peritonitis [OR = 8.486, 95% CI (2.017–35.703))] and total bilirubin [OR = 1.987, 95% CI (1.627–2.426)] were independent predictors of CA (all p < 0.01). The model's Area Under Curve(AUC) = 0.985 (95% CI, 0.975–0.994). After internal verification by Bootstrap method, the model still has high discriminative ability (AUC = 0.983), and its predicted CA curve is still in good agreement with the actual clinical CA curve.ConclusionWe found that a clinical prediction model based on abdominal pain duration, peritonitis, and total bilirubin can help clinicians quickly and effectively identify UA or CA before treatment of acute appendicitis in the elderly, so as to make more scientific clinical decisions.

Predictors of complicated appendicitis among patients presented to public referral hospitals in Harari region, Eastern Ethiopia: a case-control study

Complicated appendicitis makes up a significant proportion of acute appendicitis. There are well established associated factors for the development of complications, but the magnitude varies between developed and developing countries. This study was aimed to look for possible incriminated factors for higher rate of complicated appendicitis among patients treated in public hospitals found in the Harari region, Eastern Ethiopia. Multi-center case-control study with 1:2 was conducted on adult complicated appendicitis patients. The sample size of 414 was determined using an Open Epi and a simple random sampling technique was used to select the samples. Kobo collect was used for data collection by trained medical doctors. Data analysis was made using a statistical package for social studies version 23. The findings were presented in tables and elaborated in texts. Binary logistic regression analysis was conducted to determine association between predictors and outcome variable with adjusted odds ratio at 95% confidence interval, p value less than 0.05. A total of 402 patients included in the study with 268(66.7%) simple appendicitis and 134(33.3%) complicated appendicitis. More patients with complicated appendicitis had a history of another health facility visit compared to the simple appendicitis groups. Duration of chief complaint, history of constipation, having history of visit to health facilities without surgical intervention for their current problem and fever has shown moderate to strong associations on binary logistic regression analysis. Delayed presentation, patients who had a history of a visit to primary health care facilities and private clinics where surgical intervention not available were also found to have an increased risk of developing complicated appendicitis.

Demographic factors associated with length of stay in hospital and histological diagnosis in adults undergoing appendicectomy

Appendicectomy remains of the most common emergency operations in the United Kingdom. The exact etiologies of appendicitis remain unclear with only potential causes suggested in the literature. Social deprivation and ethnicity have both been demonstrated to influence outcomes following many operations. There are currently no studies evaluating their roles with regards to severity and outcomes following appendicectomy. Demographic data were retrieved from health records for adult patients who underwent appendicectomy between 2010-2016 within a single NHS trust. To measure social deprivation, Indices of Multiple Deprivation (IMD) rankings were used. Histology reports were reviewed and diagnosis classified into predefined categories: non-inflamed appendix, uncomplicated appendicitis, complicated appendicitis and gangrenous appendicitis. Three thousand four hundred and forty-four patients were identified. Mean age was 37.8 years (range 73 years). Using a generalized linear model, South Asian ethnicity specifically was found to be independently predictive of increased length of stay following appendicectomy (p <0.001). Amongst South Asian patients, social deprivation was found to be further predictive of longer hospital stay (p= 0.005). Deprivation was found to be a predictor of complicated appendicitis but not of gangrenous appendicitis (p= 0.01). Male gender and age were also independent predictors of positive histology for appendicitis (p <0.001 and p= 0.021 respectively). This study is the first to report an independent association between South Asian ethnicity and increased length of stay for patients undergoing appendicectomy in a single NHS trust. The associations reported in this study may be a result of differences in the pathophysiology of acute appendicitis or represent inequalities in healthcare provision across ethnic and socioeconomic groups.

Role of Hyperbilirubinaemia as a Predictor of Complicated Appendicitis in Paediatric Population.

Background:Acute appendicitis is a common surgical emergency amongst the paediatric population. Available diagnostic tools are focussed to make a diagnosis of acute appendicitis. A definitive predictive factor for the diagnosis of complicated appendicitis is lacking. Thus, this aims to analyse hyperbilirubinaemia as a predictor of complicated appendicitis amongst the paediatric population.Materials and Methods:A prospective observational study was conducted in a tertiary hospital from November 2018 to October 2019. All children undergoing emergency appendectomy were included in the study. Preoperatively, patients were evaluated clinically, and routine investigations including total and direct serum bilirubin were sent. All patients were grouped as ‘simple appendicitis’ or ’complicated appendicitis’ based on intra-operative and histological findings. Bilirubin level was compared between these groups and analysed.Results:A total of 52 children fulfilling the inclusion criteria were included. The mean age was 13.2 ± 4.2 years, and the male: female ratio was 2.1:1. Thirty-four (65.4%) had simple appendicitis and 18 (34.6%) had complicated appendicitis. Total bilirubin was 23.83 ± 5.94 mmol/L in the complicated appendicitis group and 13.15 ± 3.29 mmol/L in the simple appendicitis group. Direct bilirubin was 5.28 ± 2.22 mmol/L in complicated appendicitis and 2.62 ± 0.83 mmol/L in simple one. Both total and direct bilirubin were significantly high in the complicated group (P < 0.001) compared to the simple appendicitis group. On the Receiver operating curve (ROC), the best cutoff value for total and direct bilirubin was 21 and 5.5 mmol/L, respectively. The sensitivity and specificity of total and direct bilirubin were 72.2%, 100%, and 61.1%, and 85.3%, respectively.Conclusion:It is concluded that hyperbilirubinaemia is a good predictor for paediatric complicated appendicitis.

Predictive ability of CT findings in the differentiation of complicated and uncomplicated appendicitis: a retrospective investigation of 201 patients undergone appendectomy at initial admission

BackgroundParadigm shift toward nonoperative management (NOM) of adult appendicitis has made computed tomography (CT) more important than ever, particularly in differentiating complicated from uncomplicated disease. Complete surgical and pathological data of appendicitis in a place where appendectomy at initial admission is a standard of care would allow retrospective review of preoperative CT for performance and predictive ability in identifying those that may benefit from NOM in the future.ResultsThe study included 201 CT scans of consecutive adult patients who presented for appendectomy at initial admission with pathologically confirmed acute appendicitis. Complicated appendicitis referred to gangrene or perforation on pathological or operative findings. The overall CT sensitivity, specificity and accuracy for differentiation of complicated from uncomplicated appendicitis were 87.2%, 75.7% and 81.1%, respectively. The most sensitive CT findings of complicated appendicitis were mucosal enhancement defect (83.2%; 95% CI 74.1–90.0) and moderate-to-severe periappendiceal fat stranding (96.8%; 95% CI 91.1–99.3), both independently predictive of complicated appendicitis with adjusted odds ratios (ORs) of 4.62 (95% CI 1.86–11.51) and 4.41 (95% CI 1.06–18.29), respectively. Phlegmon, fluid collection, extraluminal appendicolith, periappendiceal air and small bowel dilatation had specificity of 98.1–100%. Intraluminal appendicoliths were found more frequently in complicated appendicitis (52.6% vs. 22.6%) but not predictive for this diagnosis. Independent clinical predictors of complicated appendicitis were lack of pain migration (OR 2.06), neutrophilia ≥ 82% (OR (2.87) and symptoms ≥ 24 h (OR 5.84).ConclusionsCT findings were highly accurate in differentiating complicated from uncomplicated appendicitis among patients undergone appendectomy at initial admission.

A study of neutrophil lymphocyte ratio (NLR) as a predictor of complicated appendicitis

Introduction: Appendicitis is one of the most common surgical pathologies. It is classified into complicated and uncomplicated appendicitis. Neutrophil Lymphocyte ratio (NLR) is an easily available lab parameter which can be used to differentiate complicated and uncomplicated appendicitis.Aims and objectives: To identify the reliability of NLR as a predictor of complicated appendicitis and to study the association of increased NLR with complicated appendicitis, among the cases of appendicitis who presented to our tertiary care centre.Methodology: This a retrospective study of all the cases operated for appendicitis in surgical department of Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation over a period of 2 years. Clinical details were retrieved from case records and data was analysed using IBM SPSS version 21. Results and conclusion: Total sample size was 250 (Male-193, Female-57), Mean age 30.6 ±15.294 years. The mean value of the NLR for Complicated appendicitis based on ROC analysis is 7.3 ± 2.98 and area under ROC curve was 0.7, with a Sensitivity of 98% and a specificity of 65% for predicting complicated appendicitis. NLR is a reliable preoperative investigation to predict complicated appendicitis.

A study to determine the value of pre operative hyperbilirubinemia as a predictor of complicated appendicitis

Background: Acute appendicitis is a common acute abdominal condition that all surgeons confront. The early detection of patients who could go in for complication is critical so that appropriate treatment can be initiated to reduce mortality. There is no pre-operative investigation which accurately point out the patients who are going to develop severe disease. Hence this prospective study was done to identify whether preoperative bilirubin level can predict the severity of the disease.Methods: The study was conducted in the Department of General Surgery, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum on 100 consecutive patients who were clinically diagnosed as acute appendicitis. These patients were evaluated with Alvarado score. In addition, preoperative bilirubin level and liver enzymes were estimated. Ultrasound abdomen was done preoperatively routinely. After surgery histopathology was studied. The parameters which showed statistically significant results for predicting complications were analyzed.Results: In this prospective study on 100 consecutive patients, acute appendicitis was found more commonly in males, 57 (57%) cases than in females, 43 (43%) cases. Among the cases 56 were acute appendicitis, 13 perforated, 11 gangrenous and 20 suppurative appendicitis. In our study, there was significant correlation of preoperative hyperbilirubinemia with complications of appendicitis.Conclusions: Patients with appendicitis with elevated bilirubin levels have more chance for complications like perforation, gangrene and suppuration.

The Role of Vascular Endothelial Growth Factor as a Predictor of Complicated Appendicitis in Animal Model Oryctolagus cuniculus

BACKGROUND: Appendicitis is the most common abdominal disease that requires surgery in children. The mortality rate in appendicitis is greatly affected by rupture or leakage of the appendix. In establishing the diagnosis of appendicitis, several modalities are needed, namely, with a pediatric appendicitis score and ultrasound. In addition to operative measures, non-operative therapeutic research is also developing, especially for cases of appendicitis without complications. Pathologically, the occurrence of complications in appendicitis is influenced by good vascularization for tissue healing through the process of angiogenesis by vascular endothelial growth factor (VEGF).&#x0D; AIM: We aimed to see the effect of VEGF and folic acid levels on the occurrence of complicated appendicitis.&#x0D; METHODS: This research method is laboratory experimental design. A total of 32 rabbits used were male rabbits weighing 2500–3000 g that met the inclusion and exclusion criteria. Samples were examined for VEGF levels and then the appendix lumen was obstructed with Silk No.-O thread. Thirteen hours later, blood samples are taken back to check VEGF and folic acid (FA) levels and an appendectomy is performed for histopathological examination.&#x0D; RESULTS: There is a decrease of basal VEGF levels regarding histopathological results. In complicated appendicitis, the basal VEGF level was lower than acute appendicitis and normal; 8.61 (±4.87), 7.66 (±3.47), and 5.75 (±4.88), respectively. Similar trend was found in basal FA levels. In complicated appendicitis, it has a lower level than both acute appendicitis and normal; 2.00 (±2.08), 1.14 (±1.00), and 0.44 (±0.22) in order. However, there is no statistical significance in both trends (p = 0.775 and p = 0.058).&#x0D; CONCLUSION: There was a trend showing low value of VEGF and FA that were a predictor of appendicitis and complicated appendicitis. Unfortunately, no statistical significance was shown in this study.

Preoperative laboratory tests as predictors of complicated appendicitis

Background and aims Diagnosis of acute appendicitis is not always straightforward; even the most experienced surgeon may remove normal appendix or sit on the perforated one. The aim of this study is to investigate the role of preoperative laboratory tests in the prediction of complicated appendicitis (CA). Patients and methods A total of 126 patients presented with right iliac fossa pain (appendicitis) were included between March 2018 and January 2019 in the Department of General Surgery, Zagazig University Hospitals. All patients underwent blood sample test, surgical exploration, and management according to operative findings. Results According to the operative and histopathological findings, the participants were divided into group A which included 72 (57%) patients with non-CA and group B which included 54 (43%) patients with CA. The preoperative laboratory predictors such as white blood cells (WBCs), international normalized ratio (INR), serum C-reactive protein (CRP), and total bilirubin (TB) were highly significantly higher in group B (P Conclusion The diagnostic accuracy of WBCs, INR, TB, and CRP were between 68% and up to 93% indicating that these preoperative laboratory tests were valid for early detection of CA. Further studies evaluating these laboratory predictors are recommended.

Diagnostic value of C-reactive protein as a predictor of complicated appendicitis like perforated/gangrenous appendicitis

Background: Appendicitis is inflammation of appendix. Appendicitis remains the most common abdominal surgical emergency. There is no reliable specific marker for acute appendicitis and its complications. C- reactive protein is an acute phase reactant produced by the liver during the acute inflammation, which rises rapidly in presence of inflammation. CRP is a more sensitive and reliable indicator of inflammatory processes than ESR and leucocyte count. The aim of this study was to evaluate whether CRP predict the severity of appendicitis.Methods: This study was hospital based, observational study. After history and clinical examination, patient underwent USG whole abdomen. Diagnosis of appendicitis was established. After that patient underwent routine blood investigations including, CRP. After confirming diagnosis of appendicitis, patients underwent appendectomy and biopsy of appendix was sent for histopathological examination.Results: In our study, CRP value &gt; 6.15mg/L has a sensitivity of 100.0% and a specificity of 54% in predicting complicated perforated or gangrenous appendicitis. The positive predictive value and negative predictive value of CRP were 100% and 61.54% respectively. The cut off level at around 6mg/dL needs to be handled carefully and a person with high CRP should undergo surgery immediately.Conclusions: This study clearly suggested that CRP leads to precise prediction of the severity of acute appendicitis for treatment. A person with high CRP should undergo surgery immediately ures.