Msolli Mohamed Amine, Beltaief Kaouther, Bouida Wahid, Jerbi Nahla, Grissa Mohamed Habib, Boubaker Hamdi, Boukef Riadh, Nouira Semir
Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia.
Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia.
BMC Emerg Med. 2018 May 24;18(1):15. doi: 10.1186/s12873-018-0166-5.
The aim of this study is to test the diagnostic value of baseline and early change of C-reactive protein (CRP) concentrations, evaluated separately or in combination with the modified Alvarado score (MAS), in patients with clinically suspected acute appendicitis.
This is a prospective observational study including all patients presenting to the emergency department with an equivocal diagnosis of acute appendicitis. After inclusion, clinical and demographic data are recorded and blood samples were taken at baseline and 3 h after for serum CRP measurements (3 h CRP). The MAS is also calculated for all patients. The ultimate diagnosis of appendicitis was based on the histologic findings of the excised appendix in operated patients and clinical follow-up in emergency department discharged patients. Diagnostic accuracy of admission CRP, early change of CRP 3 h CRP minus admission CRP, MAS and the combination of these parameters was expressed by sensitivity, specificity, positive predictive value, negative predictive value and area under receiver operating characteristics curve.
Five hundred patients were included from January 2010 to December 2013. Overall, 387 patients were operated the negative appendectomy rate was 8,3%. CRP concentrations were higher in patients with acute appendicitis. However, the diagnostic value of admission CRP, delta CRP and MAS was moderate with area under ROC curve respectively equal to 0.63, 0.53 and 0.6. Combining admission CRP and delta CRP values to MAS did not result in a better performance. The area under ROC curve did not exceed 0.7 with the different combinations.
Early change of CRP has a moderate diagnostic value in patients with clinically suspected acute appendicitis. Combining CRP values to MAS did not improve diagnostic accuracy.
本研究旨在测试C反应蛋白（CRP）浓度的基线水平和早期变化单独或与改良的阿尔瓦拉多评分（MAS）联合评估时，对临床疑似急性阑尾炎患者的诊断价值。
这是一项前瞻性观察性研究，纳入所有因急性阑尾炎诊断不明确而就诊于急诊科的患者。纳入后，记录临床和人口统计学数据，并在基线和3小时后采集血样以测量血清CRP（3小时CRP）。所有患者均计算MAS。阑尾炎的最终诊断基于手术患者切除阑尾的组织学检查结果以及急诊科出院患者的临床随访。入院时CRP、CRP的早期变化（3小时CRP减去入院时CRP）、MAS以及这些参数的组合的诊断准确性通过敏感性、特异性、阳性预测值、阴性预测值和受试者操作特征曲线下面积来表示。
2010年1月至2013年12月共纳入500例患者。总体而言，387例患者接受了手术，阴性阑尾切除率为8.3%。急性阑尾炎患者的CRP浓度较高。然而，入院时CRP、CRP变化值和MAS的诊断价值中等，ROC曲线下面积分别为0.63、0.53和0.6。将入院时CRP和CRP变化值与MAS联合使用并未带来更好的诊断性能。不同组合的ROC曲线下面积均未超过0.7。
CRP的早期变化对临床疑似急性阑尾炎患者具有中等诊断价值。将CRP值与MAS联合使用并未提高诊断准确性。
