Komparativna analiza markera trombocita i markera inflamacije u dijagnostici akutnog apendicitisa kod odraslih

Abstract

In order to reduce unnecessary laparotomies or overlooked cases of acute appendicitis (AA), a prospective clinical and biochemical study was conducted on 67 patients operated for suspected AA and the diagnostic accuracy and predictive value of platelet and inflammatory markers in the diagnosis of AA in adults and their correlation with Alvarado Scor(AS) and histopathology(HP)diagnosis were determined. After preoperative parameter determination, AS was calculated, surgery and HP appendix examination were performed and patients were divided into groups: catarrhal (CtAA), uncomplicated, phlegmonous(FAA,UCoAA), gangrenous and gangrenous perforated(CoAA). For statistical analysis, standard parametric and nonparametric tests were used. The most relevant measures in the final diagnosis of AA were the AS≥9 and the HP finding. By univariate regression, the probability ratio for AS≥9 and AS˂9 increases with a unit increase in CRP, neutrophil (Neu), neutrophil-lymphocyte ratio (NLR), total bilirubin (TBil)>21 μmol/l, procalcitonin (PCT)≥0.5ng/ml and HP finding CoAA. The probability ratio for HP finding of CoAA and UCoAA increases with a unit increase in CRP,Neu,NLR,AS,TBil>21μmol/l,PCT≥0.5ng/ml and AS≥9. Multifactor regression resulted in a model that explains 63.09% of the variability in the probability ratio of AS≥9 and AS˂9. In addition to the constant, this model consists of Neu, TBil>21μmol/l, HP finding CoAA and PCT≥0.5ng/ml. A model was also obtained that explains 54.19% of the variability in the probability ratios of the HP findings of CoAA and UCoAA. In addition to the constant, this model consists of the finding of AS≥9, the finding of PCT≥0.5ng/ml. There are strong positive correlations of AS and Neu, AS and NLR,AS and IL-6,AS and PCT,NLR and IL-6,IL-6 and PCT,IL-6 and CRP in the whole sample of patients with AA. By selecting the appropriate preoperative parameters and including them in the mathematical formula of multifactor logistic regression, the need for an appropriate method of AA treatment can be reliably assessed.