Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Ann Palliat Med. 2021 Jun;10(6):6133-6144. doi: 10.21037/apm-21-26. Epub 2021 May 24.
Exclusive antibiotic therapy is a feasible treatment option for uncomplicated appendicitis, but the pre-treatment diagnosis of uncomplicated appendicitis is challenging. This study aimed to develop a risk score system to predict complicated appendicitis and aiding decision-making regarding antibiotic therapy for acute appendicitis.
The risk score system for predicting complicated appendicitis was constructed and validated by a surgical therapy cohort (n=543). Furthermore, we applied an independent antibiotic treatment cohort (n=169) to verify whether the risk score system could guide antibiotic treatment decision-making in patients with acute appendicitis (AA).
A total of 543 patients were included in the surgical therapy cohort and was split into the primary (n=375) and validation (n=168) cohorts with repeated random sampling. In the primary cohort, multivariate analysis confirmed that periappendiceal fat stranding (PFS, P<0.001, OR =67.80), the C-reactive protein level (CRP ≥38 mg/L, P<0.001, OR =5.77) and the neutrophil-to-lymphocyte ratio (NLR ≥7, P<0.001, OR =3.51) were independent risk factors for complicated appendicitis. The PFS, CRP and NLR scores were 10.0, 4.0 and 3.0 points, respectively. Fourteen patients (3.7%, 14/375) and seven patients (4.2%, 7/168) with pathologically confirmed complicated appendicitis were classified as having uncomplicated appendicitis in the primary and validation cohorts based on the risk score system, respectively. In the independent antibiotic treatment cohort (n=169), the failure rate of antibiotic treatment was 49.2% and 5.3% for the risk score system predicted complicated AA and uncomplicated AA. Furthermore, the predictive accuracy of the risk score system for antibiotic treatment failure as measured by the area under the curve (AUC) was 0.823 (95% CI: 0.757-0.878).
We found that the proposed risk score system based on biological and CT features not only enables the accurate identification of complicated appendicitis patients before pre-treatment but also serves to guide antibiotic treatment decisions.
单纯抗生素治疗是一种可行的治疗选择，适用于单纯性阑尾炎，但单纯性阑尾炎的术前诊断具有挑战性。本研究旨在建立一种预测复杂性阑尾炎的风险评分系统，并辅助决策急性阑尾炎的抗生素治疗。
通过外科治疗队列（n=543）构建并验证了预测复杂性阑尾炎的风险评分系统。此外，我们应用了一个独立的抗生素治疗队列（n=169）来验证该风险评分系统是否可以指导急性阑尾炎（AA）患者的抗生素治疗决策。
共有 543 例患者纳入外科治疗队列，分为主要（n=375）和验证（n=168）队列，采用重复随机抽样。在主要队列中，多变量分析证实阑尾周围脂肪条纹（PFS，P<0.001，OR=67.80）、C 反应蛋白水平（CRP≥38mg/L，P<0.001，OR=5.77）和中性粒细胞与淋巴细胞比值（NLR≥7，P<0.001，OR=3.51）是复杂性阑尾炎的独立危险因素。PFS、CRP 和 NLR 评分分别为 10.0、4.0 和 3.0 分。根据风险评分系统，主要和验证队列中分别有 14 例（3.7%，14/375）和 7 例（4.2%，7/168）病理证实的复杂性阑尾炎患者被归类为单纯性阑尾炎。在独立的抗生素治疗队列（n=169）中，根据风险评分系统预测为复杂性 AA 和单纯性 AA 的抗生素治疗失败率分别为 49.2%和 5.3%。此外，风险评分系统预测抗生素治疗失败的曲线下面积（AUC）为 0.823（95%CI：0.757-0.878），表明预测准确性较高。
我们发现，该基于生物和 CT 特征的风险评分系统不仅可以在术前准确识别复杂性阑尾炎患者，还可以指导抗生素治疗决策。
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