Predictive factors of perforated appendicitis: Impact of the C-reactive protein level

Abstract

Background Perforated appendicitis without an associated abscess necessitates emergency surgery. However, it is difficult to predict the presence of perforation before surgery, and the predictive factors are still unclarified. Our purposes were to characterize a patient population with perforated appendicitis without an associated abscess to identify the preoperative predictive factors of appendiceal perforation. Methods We retrospectively identified 150 patients who underwent appendectomy for acute appendicitis at our institution from June 2018 to November 2020. Logistic regression analysis was performed to analyze the concurrent effects of various factors on the prevalence of perforated appendicitis. Results Forty (29%) of 150 patients had appendiceal perforation detected intraoperatively. Of these 40 patients, only 19 had appendiceal perforation detected on preoperative computed tomography. Multivariable analysis found that a higher C-reactive protein level, higher total bilirubin level, and the presence of an appendiceal fecalith were independent predictive factors for appendicitis with perforation. Conclusion Our analysis suggests that the presence of an appendiceal fecalith, a total bilirubin level of more than 21.38 μmol/L, and a C-reactive protein level of more than 3.0 × 10 4 μg/L are predictive factors of perforated appendicitis.

Perforation and surgical prognosis of acute appendicitis, and a prediction nomogram for perforated appendicitis in adults: a retrospective study

“…Previous studies have reported a higher incidence of appendiceal perforation among vulnerable populations, including the elderly, racial minorities, individuals with high comorbidity, low socioeconomic status, and those without insurance [20][21][22] . In a recent study involving 150 patients with acute appendicitis, older individuals had a higher rate of appendiceal perforation compared to younger patients (64.5 years vs 38.5 years, p < 0.001) 23 . However, Our study found that age and the Charlson Comorbidity Index (aCCI) were not the main risk factors for appendiceal perforation, as no statistically signi cant differences were observed in the multivariate logistic regression analysis.…”

Çocuklarda komplike apandisit tanısında bilirubin ve C-reaktif protein yüksekliğinin değerlendirilmesi

“…The CRP level is used to support clinical data in making an operation decision (26)(27)(28) . It is stated that CRP elevation is an important marker in differentiating complicated appendicitis (5,8) . The CRP value increases more in children with high inflammatory response, such as complicated appendicitis (24,25) .…”

“…Although many inflammatory markers are used for the diagnosis of acute complicated appendicitis, there is still no specific biomarker. It has been reported that high C-reactive protein (CRP) is an important marker in differentiating acute complicated appendicitis (5,8) . Total serum bilirubin (TSB), which has recently been accepted as a marker in diagnosing complicated appendicitis, also increases in infectious diseases involving organs other than the liver (9) .…”

Related Markers for the Precision Diagnosis of Complex Appendicitis in Children

“…Bilirubin levels are highly specific for the diagnosis of complicated appendicitis; a 2.0-fold increase in the likelihood of complicated appendicitis was observed in patients with elevated bilirubin levels ( Noh et al, 2012 ). In addition, total bilirubin > 21.38 mol/L was a predictor of appendicitis perforation ( Yamazaki et al, 2021 ). As serum bilirubin level is an economical, simple, and available laboratory index, it should be recommended for preliminary evaluation of acute appendicitis in pediatric patients.…”