General Surgeon, Department of Surgery at Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.
General Surgeon, Department of Surgery at Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.
J Surg Res. 2021 May;261:369-375. doi: 10.1016/j.jss.2020.12.050. Epub 2021 Jan 22.
Multiple serologic markers have been studied to predict complicated acute appendicitis (CAA) (C-reactive protein and procalcitonin); these increase health care costs and are not always available in medical centers in Mexico. There is a need for low-cost serologic markers to predict CAA and guide the preoperative management of patients. Our objective was to analyze the predictive value of hyponatremia and thrombocytosis for complicated acute appendicitis.
We analyzed 274 patients with AA surgically treated and divided them into two groups: the CAA group and the uncomplicated AA group. We compared the serum values of sodium and platelet blood counts on presentation in the emergency room between the two groups and the proportion of patients with hyponatremia and/or thrombocytosis. Receiver operating characteristic analysis was performed for the two biochemical markers. Sensitivity, specificity, and positive and negative predictive values were calculated for complicated appendicitis in the presence of hyponatremia and thrombocytosis.
We found 87 patients with CAA and 187 with uncomplicated acute appendicitis. Patients with CAA presented with lower serum sodium values and higher platelet counts than uncomplicated patients. Hyponatremia was found in 54.8% of complicated patients and 29.2% in the uncomplicated group. Thrombocytosis was present in 11.6% of the complicated group and 3.2% in uncomplicated patients. We found a specificity and positive predictive value of 100% for complicated appendicitis in patients with hyponatremia and thrombocytosis.
In patients with abdominal pain and suspected acute appendicitis, the presence of hyponatremia and thrombocytosis is a strong predictive tool for the complicated disease. This is the first study to analyze the association between thrombocytosis and complicated appendicitis.
已经研究了多种血清标志物来预测复杂急性阑尾炎（CAA）（C 反应蛋白和降钙素原）；这些标志物增加了医疗保健成本，并且在墨西哥的医疗中心并非总是可用。需要低成本的血清标志物来预测 CAA 并指导患者的术前管理。我们的目的是分析低钠血症和血小板增多症对复杂急性阑尾炎的预测价值。
我们分析了 274 例接受手术治疗的 AA 患者，并将他们分为两组：CAA 组和非复杂 AA 组。我们比较了两组患者在急诊室就诊时的血清钠值和血小板计数，并比较了低钠血症和/或血小板增多症患者的比例。对两种生化标志物进行了接受者操作特征分析。计算了低钠血症和血小板增多症存在时复杂性阑尾炎的敏感性、特异性、阳性和阴性预测值。
我们发现 87 例患者患有 CAA，187 例患者患有非复杂性急性阑尾炎。患有 CAA 的患者血清钠值较低，血小板计数较高，而非复杂性患者。复杂患者中低钠血症的发生率为 54.8%，而非复杂患者为 29.2%。复杂组中血小板增多症的发生率为 11.6%，非复杂组为 3.2%。我们发现，低钠血症和血小板增多症患者的复杂性阑尾炎的特异性和阳性预测值均为 100%。
在有腹痛和疑似急性阑尾炎的患者中，低钠血症和血小板增多症是复杂疾病的强有力预测工具。这是首次分析血小板增多症与复杂阑尾炎之间的关联的研究。
