Department of General Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey.
Eur Rev Med Pharmacol Sci. 2022 Feb;26(3):820-827. doi: 10.26355/eurrev_202202_27990.
Both life expectancy and the proportion of the population in elderly are increasing. Therefore, the number of cases of acute appendicitis (AA) among the super-elderly population is increasing. In this study, it is aimed to find the correlations between morbidity and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), albumin and prognostic nutritional index (PNI) in super-elderly patients.
In this retrospective study, we studied super-elderly patients (85 years old and above) who were operated on due to AA between January 2015 and January 2020 at a tertiary health center. After approval by the ethics committee, patients' preoperative, peroperative and postoperative data were collected. Patients were divided into two groups: the morbidity-positive (+) group and the morbidity-negative (-) group. The differences between the two groups regarding the parameters investigated were evaluated.
25 super-elderly patients were operated on for AA. There were 7 patients in the morbidity (+) group and 18 in the morbidity (-) group. The area under the curve (AUC) for NLR was 0.476 ([95% CI: 0.215-0.738]; p = 0.856), and the AUC for PLR was 0.444 ([95% CI: 0.193-0.696]; p = 0.672). However, the AUC for PNI was 0.810 ([95% CI: 0.569-1.000]; p = 0.018), and the AUC for albumin was 0.845 ([95% CI: 0.601-1.000]; p = 0.008). At the cut-off value of 3.35 g/dL, albumin's sensitivity was 88.9% and its specificity was 85.7%. At the cut-off value of 38, PNI's sensitivity was 94.4% and its specificity was 71.4%.
The present study found that PNI and albumin values can be used as prognostic factors and have high sensitivity and specificity. Therefore, this study is a leader study in identifying prognostic factors for AA that can be used in the super-elderly geriatric population. However, the possibility of statistical error should be minimized by conducting studies involving more patients.
预期寿命和老年人口比例都在增加。因此，超高龄人群中急性阑尾炎（AA）的病例数正在增加。本研究旨在探讨超高龄患者中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、白蛋白和预后营养指数（PNI）与发病率之间的相关性。
本回顾性研究纳入了 2015 年 1 月至 2020 年 1 月在一家三级保健中心因 AA 接受手术的超高龄患者（85 岁及以上）。在伦理委员会批准后，收集了患者术前、术中和术后的数据。患者分为发病率阳性（+）组和发病率阴性（-）组。评估两组间所研究参数的差异。
25 例超高龄患者因 AA 接受手术。发病率（+）组 7 例，发病率（-）组 18 例。NLR 的曲线下面积（AUC）为 0.476（[95%CI：0.215-0.738]；p=0.856），PLR 的 AUC 为 0.444（[95%CI：0.193-0.696]；p=0.672）。然而，PNI 的 AUC 为 0.810（[95%CI：0.569-1.000]；p=0.018），白蛋白的 AUC 为 0.845（[95%CI：0.601-1.000]；p=0.008）。在 3.35g/dL 的截断值时，白蛋白的灵敏度为 88.9%，特异性为 85.7%。在 38 的截断值时，PNI 的灵敏度为 94.4%，特异性为 71.4%。
本研究发现 PNI 和白蛋白值可作为预测因子，具有较高的灵敏度和特异性。因此，本研究在确定可用于超高龄老年人群的 AA 预后因素方面处于领先地位。然而，通过开展涉及更多患者的研究，可以最大限度地减少统计误差的可能性。
