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Afzal B, Cirocchi R, Dawani A, Desiderio J, Di Cintio A, Di Nardo D, Farinacci F, Fung J, Gemini A, Guerci L, Kam SYM, Lakunina S, Madi L, Mazzetti S, Nadyrshine B, Shams O, Ranucci MC, Ricci F, Sharmin A, Trastulli S, Yasin T, Bond-Smith G, Tebala GD. Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables. World J Emerg Surg 2023; 18:10. [PMID: 36707812 PMCID: PMC9882741 DOI: 10.1186/s13017-023-00478-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Recent evidence confirms that the treatment of acute appendicitis is not necessarily surgical, and selected patients with uncomplicated appendicitis can benefit from a non-operative management. Unfortunately, no cost-effective test has been proven to be able to effectively predict the degree of appendicular inflammation as yet, therefore, patient selection is too often left to the personal choice of the emergency surgeon. Our paper aims to clarify if basic and readily available blood tests can give reliable prognostic information to build up predictive models to help the decision-making process. METHODS Clinical notes of 2275 patients who underwent an appendicectomy with a presumptive diagnosis of acute appendicitis were reviewed, taking into consideration basic preoperative blood tests and histology reports on the surgical specimens. Variables were compared with univariate and multivariate analysis, and predictive models were created. RESULTS 18.2% of patients had a negative appendicectomy, 9.6% had mucosal only inflammation, 53% had transmural inflammation and 19.2% had gangrenous appendicitis. A strong correlation was found between degree of inflammation and lymphocytes count and CRP/Albumin ratio, both at univariate and multivariate analysis. A predictive model to identify cases of gangrenous appendicitis was developed. CONCLUSION Low lymphocyte count and high CRP/Albumin ratio combined into a predictive model may have a role in the selection of patients who deserve appendicectomy instead of non-operative management of acute appendicitis.
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Affiliation(s)
- Barza Afzal
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Roberto Cirocchi
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Aruna Dawani
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Jacopo Desiderio
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Antonio Di Cintio
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Domenico Di Nardo
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Federico Farinacci
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - James Fung
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Alessandro Gemini
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Lorenzo Guerci
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Sen Yin Melina Kam
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Svetlana Lakunina
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Lee Madi
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Stefano Mazzetti
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Bakhtiar Nadyrshine
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Ola Shams
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Maria Chiara Ranucci
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Francesco Ricci
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Afroza Sharmin
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Stefano Trastulli
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Tanzela Yasin
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Giles Bond-Smith
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Giovanni D. Tebala
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK ,grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
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