Correlation between the serum and tissue levels of oxidative stress markers and the extent of inflammation in acute appendicitis

Abstract

OBJECTIVES:To determine the serum and tissue levels of markers of impaired oxidative metabolism and correlate these levels with the histopathology and Alvarado score of acute appendicitis patients.METHOD:Sixty-five acute appendicitis patients (mean age, 31.4±12.06 years; male/female, 30/35) and 30 healthy control subjects were studied. The Alvarado score was recorded. Serum samples were obtained before surgery and 12 hours postoperatively to examine the total antioxidant status, total oxidant status, paraoxonase, stimulated paraoxonase, arylesterase, catalase, myeloperoxidase, ceruloplasmin, oxidative stress markers (advanced oxidized protein products and total thiol level) and ischemia-modified albumin. Surgical specimens were also evaluated.RESULTS:The diagnoses were acute appendicitis (n = 37), perforated appendicitis (n = 8), phlegmonous appendicitis (n = 12), perforated+phlegmonous appendicitis (n = 4), or no appendicitis (n = 4). The Alvarado score of the acute appendicitis group was significantly lower than that of the perforated+phlegmonous appendicitis group (p = 0.004). The serum total antioxidant status, total thiol level, advanced oxidized protein products, total oxidant status, catalase, arylesterase, and ischemia-modified albumin levels were significantly different between the acute appendicitis and control groups. There was no correlation between the pathological extent of acute appendicitis and the tissue levels of the markers; additionally, there was no correlation between the tissue and serum levels of any of the parameters.CONCLUSIONS:The imbalance of oxidant/antioxidant systems plays a role in the pathogenesis acute appendicitis. The Alvarado score can successfully predict the presence and extent of acute appendicitis.

Should Alvarado and Ohmann Scorings Be Real Indicators In The Diagnosis Of Appendicitis and the Severity of Inflammation?

“…[9,17] Many studies have been performed affirming general validity for predicting acute appendicitis. Dumlu et al [18] stated in a study they performed that as Alvarado score increased, inflammation also increased. In a study performed by Kariman et al, [19] patients who presented with acute abdominal pain and had result greater than 7 on Alvarado scoring system were 93% more likely to be diagnosed with acute appendicitis, while patients with score below 7 had 26% chance of being diagnosed with acute appendicitis.…”

“…No strong correlation was observed in their findings despite statistical significance. Dumlu et al [18] classified patient groups in terms of severity of inflammation as having acute appendicitis, perforated appendix, perforation + phlegmonous appendicitis, or perforated appendix and negative appendectomy. Correlation was observed between severity of inflammation and Alvarado scoring system.…”

Correlation between ischemia-modified albumin and Ranson score in acute pancreatitis

“…However, the authors found no correlation between the pathological extent of acute appendicitis and oxidative stress markers. [26] In another study, plasma IMA level was found to be significantly higher in acute mesenteric ischemia in comparison to the nonoccluded group, suggesting that IMA might have a diagnostic value in acute thromboembolic occlusion of mesenteric vessels. [2] In the literature, there are only two studies on the association between IMA and AP.…”

“…[2,26,27] In one of those, serum levels of oxidative stress markers including IMA were found to be higher in patients with acute appendicitis than in healthy individuals. However, the authors found no correlation between the pathological extent of acute appendicitis and oxidative stress markers.…”

Thiol–disulfide Homeostasis in Acute Appendicitis

“…It is well known that the balance between oxidants and antioxidants is crucial in the pathogenesis of AA (5). However, whether oxidative stress is caused by an inflammatory response or an increase in free radicals is sufficient for activating the enzymatic defense system is not clear (6).…”