Department of Surgery, John Hunter Hospital, Newcastle, NSW, Australia; University of Newcastle, NSW, Australia.
Hunter Medical Research Institute, Newcastle, NSW, Australia.
Surgeon. 2019 Oct;17(5):284-290. doi: 10.1016/j.surge.2018.08.007. Epub 2018 Oct 9.
Previous studies have shown single CRP measurements at time of presentation to have limited predictive benefit for appendicitis. Our objective was to determine the diagnostic utility of serial CRP measurements (to determine CRP velocity [CRPv]) in patients with right iliac fossa (RIF) pain.
A single-centre prospective observational study was conducted on adult patients admitted with RIF pain. CRP was measured on admission, at midnight, and the following morning. Appendicitis was diagnosed on histopathology, or diagnostic imaging in non-operatively managed patients. Therapeutic interventions included all appropriate operative procedures and effective non-operative treatment with antibiotics. Logistic regression was used to generate predictors of therapeutic intervention, and then used to create a new risk score incorporating CRPv.
98 of 112 (87.5%) participants had complete CRP data. 58 patients met the criteria for appendicitis (59.2%). Most patients presented with intermediate Modified Alvarado Scores (MAS) 5-6 (40.8%) or Appendicitis Inflammatory Response Scores (AIRS) 5-8 (49%). Our risk score had an AUROC of 0.88 (95% CI 0.81-0.96) in predicting therapeutic intervention. This score was superior to MAS, AIRS, and single admission biomarker measurements. Patients with an increasing CRPv had 14 times the odds (OR 14.07, 95% CI 0.63-315.2) of complicated appendicitis, and no cases of complicated appendicitis were observed in patients with a flat CRPv.
CRP velocity is superior to single CRP at predicting intervention. Our v-Score shows promise as a decision making-aide by predicting the need for surgical intervention in RIF pain. A flat CRPv identifies a group of patients with a very low risk of complicated appendicitis.
先前的研究表明，在就诊时进行单次 CRP 测量对阑尾炎的预测益处有限。我们的目的是确定连续 CRP 测量（确定 CRP 速度[CRPv]）在右髂窝（RIF）疼痛患者中的诊断效用。
对因 RIF 疼痛入院的成年患者进行了一项单中心前瞻性观察性研究。入院时、午夜和次日早上测量 CRP。在接受手术治疗的患者中，通过组织病理学或诊断性影像学检查诊断为阑尾炎。治疗干预包括所有适当的手术程序和有效的非手术抗生素治疗。使用逻辑回归生成治疗干预的预测因子，然后使用该预测因子创建新的风险评分，纳入 CRPv。
112 名参与者中有 98 名（87.5%）有完整的 CRP 数据。58 名患者符合阑尾炎标准（59.2%）。大多数患者表现为中等程度的改良 Alvarado 评分（MAS）5-6（40.8%）或阑尾炎炎症反应评分（AIRS）5-8（49%）。我们的风险评分在预测治疗干预方面的 AUC 为 0.88（95%CI 0.81-0.96）。该评分优于 MAS、AIRS 和单次入院生物标志物测量。CRPv 升高的患者发生复杂性阑尾炎的几率是 CRPv 不变患者的 14 倍（OR 14.07，95%CI 0.63-315.2），且 CRPv 不变的患者无一例发生复杂性阑尾炎。
CRPv 比单次 CRP 更能预测干预。我们的 v 评分有望成为决策辅助工具，通过预测 RIF 疼痛患者是否需要手术干预来帮助决策。CRPv 不变可识别一组复杂性阑尾炎风险极低的患者。
