BACKGROUND:This study aimed to investigate the role of inflammatory markers in decreasing negative appendectomy rate (NAR) based on their relation with findings of acute appendicitis (AA) on computed tomography (CT).
The value of abdominal computed tomography in non-traumatic abdominal pain has been well established. On the other hand, to manage computed tomography, appropriateness has become more of an issue as a result of the concomitant increase in patient radiation exposure with increased computed tomography use. The purpose of this study was to investigate whether C-reactive protein, white blood cell count, and pain location may guide the selection of patients for computed tomography in non-traumatic acute abdomen. Patients presenting with acute abdomen to the emergency department over a 12-month period and who subsequently underwent computed tomography were retrospectively reviewed. Those with serum C-reactive protein and white blood cell count measured on admission or within 24 h of the computed tomography were selected. Computed tomography examinations were retrospectively reviewed, and final diagnoses were designated either positive or negative for pathology relating to presentation with acute abdomen. White blood cell counts, C-reactive protein levels, and pain locations were analyzed to determine whether they increased or decreased the likelihood of producing a diagnostic computed tomography. The likelihood ratio for computed tomography positivity with a C-reactive protein level above 5 mg/L was 1.71, while this increased to 7.71 in patients with combined elevated C-reactive protein level and white blood cell count and right lower quadrant pain. Combined elevated C-reactive protein level and white blood cell count in patients with right lower quadrant pain may represent a potential factor that could guide the decision to perform computed tomography in non-traumatic acute abdomen.
Aim Comprehensive studies on the coexistence of COVID-19 and pericardial effusion (PEff) are limited. In this study, we investigated the relationship between pneumonia severity and PEff, predisposing factors, and the effect of PEff on clinical prognosis and mortality in COVID-19 patients.Material and methods Between March and November 2020, 5 575 patients were followed up in our pandemic hospital due to COVID-19. 3 794 patients with positive polymerase chain reaction (PCR) test results and thoraxcomputerized tomography (CT) imaging at admission were included in the study. The clinical and demographic characteristics, CT images, hematological and biochemical parameters of these patients were retrospectively examined. Pulmonary involvement of 3794 patients was divided into three groups and its relationship with PEff was investigated retrospectively.Results There were 560 patients who did not have pulmonary involvement, 2 639 patients with pulmonary involvement below 50 %, and 595 patients with 50 % or more pulmonary involvement. As pulmonaryinvolvement or the severity of the disease increased, male gender and advanced age become statistically significant. The mean age of patients with PEff was higher, and PEff was more common in males. Patients with PEff had more comorbid diseases and significantly elevated serum cardiac and inflammatory biomarkers. The need for intensive care and mortality rates were higher in these patients. While the in-hospital mortality rate was 56.9 % in patients with PEff and pulmonary involvement above 50 %, in-hospital mortality rate was 34.4 % in patients with pulmonary involvement above 50 % and without PEff (p<0.001).The presence of PEff during admission for COVID-19 disease, the appearance of PEff or increase in the degree of PEff during follow-up were closely related to mortality and prognosis.Conclusion As the severity of pulmonary involvement or the clinical severity of the disease increased, PEff occurred in patients or the degree of PEff increased. The clinical prognosis of patients presenting with PEff was quite poor, and the frequency of intensive care admissions and mortality were significantly higher. PEff was an important finding in the follow-up and management of patients with COVID-19, and it reflected the clinical prognosis.
Amaç: Bu çalışma, koronavirüs hastalığı-2019 (COVID-19) hastalarında laboratuvar parametreleri, toraks bilgisayarlı tomografisi (BT) şiddet skoru (CTSS) ve COVID-19 Raporlama ve Veri Sistemi (CO-RADS) arasındaki ilişkiyi belirlemeyi amaçlamaktadır. Gereç ve Yöntem: COVID-19 semptomları ile acil servise başvuran ve başvuru anında toraks BT çekilmiş olan, polimeraz zincir reaksiyon testi ile COVID-19 olduğu doğrulanan 91 hasta çalışmaya dahil edildi. Hastaların 25-hydroksivitamin D [25(OH)D] seviyeleri, eritrosit sedimantasyon hızı (ESR), C-reaktif protein (CRP), D-dimer, glikoz, ferritin, kreatinin, alanin aminotransferaz, aspartat aminotransferaz, fosfor ve kalsiyum seviyeleri ile birlikte CO-RADS ve CTSS verileri retrospektif olarak kaydedildi. Laboratuvar parametrelerinin radyolojik bulgularla korelasyonu incelendi. Bulgular: CTSS ile yaş, ESR, CRP, D-dimer arasında pozitif korelasyon bulunurken, CTSS ile lenfosit sayısı arasında negatif korelasyon bulundu. Yüksek CTSS seviyeleri olan hastalarda daha yüksek ESR, CRP, D-dimer, ferritin değerleri ve daha düşük lenfosit sayısı ile kalsiyum seviyeleri vardı. Tipik CO-RADS tutulumu olan hastalar daha yüksek sedimantasyon, CRP, glikoz ve ferritin seviyelerine ve daha düşük lenfosit sayısına sahipti. 25(OH)D düzeyi ile CO-RADS ve CTSS arasında anlamlı bir ilişki saptanmadı. Sonuç: Bu çalışmanın sonuçları, düşük lenfosit sayısı, yüksek D-dimer, sedimantasyon, ferritin ve CRP düzeylerinin COVID-19 hastalarında şiddetli akciğer tutulumunun belirleyicileri olduğunu düşündürmektedir. Hipokalsemi, BT ile değerlendirilen COVID-19 hastalarında ciddi akciğer tutulumunun bir belirteci olarak da düşünülebilir. D vitamini eksikliği ve COVID-19 pnömonisinin ilişkisi ileri çalışmalarda araştırılmalıdır. Anahtar kelimeler: COVID-19, CO-RADS, CTSS, gerçek zamanlı polimeraz zincir reaksiyonu, vitamin D eksikliği, hipokalsemi
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