Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables
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 pred...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-01-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-023-00478-8 |
| _version_ | 1828051844330422272 |
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| author | Barza Afzal Roberto Cirocchi Aruna Dawani Jacopo Desiderio Antonio Di Cintio Domenico Di Nardo Federico Farinacci James Fung Alessandro Gemini Lorenzo Guerci Sen Yin Melina Kam Svetlana Lakunina Lee Madi Stefano Mazzetti Bakhtiar Nadyrshine Ola Shams Maria Chiara Ranucci Francesco Ricci Afroza Sharmin Stefano Trastulli Tanzela Yasin Giles Bond-Smith Giovanni D. Tebala |
| author_facet | Barza Afzal Roberto Cirocchi Aruna Dawani Jacopo Desiderio Antonio Di Cintio Domenico Di Nardo Federico Farinacci James Fung Alessandro Gemini Lorenzo Guerci Sen Yin Melina Kam Svetlana Lakunina Lee Madi Stefano Mazzetti Bakhtiar Nadyrshine Ola Shams Maria Chiara Ranucci Francesco Ricci Afroza Sharmin Stefano Trastulli Tanzela Yasin Giles Bond-Smith Giovanni D. Tebala |
| author_sort | Barza Afzal |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-10T19:44:33Z |
| format | Article |
| id | doaj.art-c58dd64c16d24689b357e1e29fae6f3f |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-04-10T19:44:33Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-c58dd64c16d24689b357e1e29fae6f3f2023-01-29T12:07:22ZengBMCWorld Journal of Emergency Surgery1749-79222023-01-011811910.1186/s13017-023-00478-8Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variablesBarza Afzal0Roberto Cirocchi1Aruna Dawani2Jacopo Desiderio3Antonio Di Cintio4Domenico Di Nardo5Federico Farinacci6James Fung7Alessandro Gemini8Lorenzo Guerci9Sen Yin Melina Kam10Svetlana Lakunina11Lee Madi12Stefano Mazzetti13Bakhtiar Nadyrshine14Ola Shams15Maria Chiara Ranucci16Francesco Ricci17Afroza Sharmin18Stefano Trastulli19Tanzela Yasin20Giles Bond-Smith21Giovanni D. Tebala22Surgical Emergency Unit, Oxford University Hospital NHS Foundation TrustDigestive and Emergency Surgery Unit, S.Maria Hospital TrustSurgical Emergency Unit, Oxford University Hospital NHS Foundation TrustDigestive and Emergency Surgery Unit, S.Maria Hospital TrustDigestive and Emergency Surgery Unit, S.Maria Hospital TrustDigestive and Emergency Surgery Unit, S.Maria Hospital TrustDigestive and Emergency Surgery Unit, S.Maria Hospital TrustSurgical Emergency Unit, Oxford University Hospital NHS Foundation TrustDigestive and Emergency Surgery Unit, S.Maria Hospital TrustDigestive and Emergency Surgery Unit, S.Maria Hospital TrustSurgical Emergency Unit, Oxford University Hospital NHS Foundation TrustSurgical Emergency Unit, Oxford University Hospital NHS Foundation TrustSurgical Emergency Unit, Oxford University Hospital NHS Foundation TrustDigestive and Emergency Surgery Unit, S.Maria Hospital TrustSurgical Emergency Unit, Oxford University Hospital NHS Foundation TrustSurgical Emergency Unit, Oxford University Hospital NHS Foundation TrustDigestive and Emergency Surgery Unit, S.Maria Hospital TrustDigestive and Emergency Surgery Unit, S.Maria Hospital TrustSurgical Emergency Unit, Oxford University Hospital NHS Foundation TrustDigestive and Emergency Surgery Unit, S.Maria Hospital TrustSurgical Emergency Unit, Oxford University Hospital NHS Foundation TrustSurgical Emergency Unit, Oxford University Hospital NHS Foundation TrustSurgical Emergency Unit, Oxford University Hospital NHS Foundation TrustAbstract 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.https://doi.org/10.1186/s13017-023-00478-8Acute appendicitisAppendicectomyPredictive modelsLymphocyte countc-reactive proteinAlbumin |
| spellingShingle | Barza Afzal Roberto Cirocchi Aruna Dawani Jacopo Desiderio Antonio Di Cintio Domenico Di Nardo Federico Farinacci James Fung Alessandro Gemini Lorenzo Guerci Sen Yin Melina Kam Svetlana Lakunina Lee Madi Stefano Mazzetti Bakhtiar Nadyrshine Ola Shams Maria Chiara Ranucci Francesco Ricci Afroza Sharmin Stefano Trastulli Tanzela Yasin Giles Bond-Smith Giovanni D. Tebala Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables World Journal of Emergency Surgery Acute appendicitis Appendicectomy Predictive models Lymphocyte count c-reactive protein Albumin |
| title | Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables |
| title_full | Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables |
| title_fullStr | Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables |
| title_full_unstemmed | Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables |
| title_short | Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables |
| title_sort | is it possible to predict the severity of acute appendicitis reliability of predictive models based on easily available blood variables |
| topic | Acute appendicitis Appendicectomy Predictive models Lymphocyte count c-reactive protein Albumin |
| url | https://doi.org/10.1186/s13017-023-00478-8 |
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