Department of Surgery, General Hospital of Carapicuiba, 95, Pedreira street, Carapicuiba, 06321-665, SP, Brazil.
Medical School, São Camilo University Center, Nazare Avenue, São Paulo, 1501, 04263- 200, SP, Brazil.
BMC Surg. 2023 Oct 14;23(1):312. doi: 10.1186/s12893-023-02224-y.
Early and accurate preoperative diagnosis of complicated appendicitis mandates the identification of new markers. The aim of this study is to determine whether preoperative serum sodium levels are useful for predicting the severity of acute appendicitis.
We retrospectively analyzed 475 patients who underwent emergency appendectomies between January 2018 and February 2023 in a general hospital in Brazil. The patients were divided into 2 groups: complicated (n = 254) and uncomplicated (n = 221). Hyponatremia was defined as serum sodium levels < 136 mEq/L. The primary outcome was to evaluate if hyponatremia is associated with complicated appendicitis.
The patients had a median age of 22 years, and the median serum sodium level was 137 mEq/L in patients with complicated appendicitis and 139 mEq/L in uncomplicated appendicitis (P < 0.001). The analysis of the receiver operating characteristic curve used as the best cutoff value of serum sodium of 136 mEq/L with a sensitivity of 45.7%, specificity of 86.4%, positive predictive value of 79.5%, and negative predictive value of 58.1% for the diagnosis of complicated AA. Of the 254 patients with complicated appendicitis, 84 (33.1%) had serum sodium levels below 136 mEq/L, while only 12 (5.4%) patients with uncomplicated appendicitis had values below this cutoff. Patients with hyponatremia were 5 times more likely to develop complicated appendicitis. (odds ratio: 5.35; 95% confidence interval: 3.39-8.45) CONCLUSIONS: Preoperative serum sodium levels are a useful tool for predicting the severity of acute appendicitis. Due to its low cost and wide availability, it has become an extremely relevant marker.
早期、准确的复杂阑尾炎术前诊断需要确定新的标志物。本研究旨在确定术前血清钠水平是否有助于预测急性阑尾炎的严重程度。
我们回顾性分析了 2018 年 1 月至 2023 年 2 月期间在巴西一家综合医院接受急诊阑尾切除术的 475 例患者。将患者分为 2 组：复杂组（n=254）和非复杂组（n=221）。低钠血症定义为血清钠水平<136 mEq/L。主要结局是评估低钠血症是否与复杂阑尾炎相关。
患者的中位年龄为 22 岁，复杂阑尾炎患者的中位血清钠水平为 137 mEq/L，非复杂阑尾炎患者的中位血清钠水平为 139 mEq/L（P<0.001）。使用作为血清钠最佳截断值 136 mEq/L 的受试者工作特征曲线进行分析，其诊断复杂 AA 的敏感性为 45.7%，特异性为 86.4%，阳性预测值为 79.5%，阴性预测值为 58.1%。在 254 例复杂阑尾炎患者中，84 例（33.1%）血清钠水平低于 136 mEq/L，而仅有 12 例（5.4%）非复杂阑尾炎患者的血清钠水平低于此截断值。低钠血症患者发生复杂阑尾炎的可能性增加 5 倍（比值比：5.35；95%置信区间：3.39-8.45）。
术前血清钠水平是预测急性阑尾炎严重程度的有用工具。由于其成本低且易于获得，因此成为一种极具相关性的标志物。
