Department of Surgical Gastroenterology, Samsun Training and Research Hospital, 55090 Samsun, Turkey.
Department of General Surgery, Samsun Training and Research Hospital, 55090 Samsun, Turkey.
Medicina (Kaunas). 2024 Nov 9;60(11):1844. doi: 10.3390/medicina60111844.
: The best way to distinguish complicated acute appendicitis (CAA) from uncomplicated acute appendicitis (UCAA) is still under debate. The aim of this study was to investigate the potential use of the serum sodium (Na) level and the neutrophil-to-lymphocyte ratio (NLR) to distinguish CAA from UCAA and to evaluate whether CAA is more reliably diagnosed using these two variables together. : This was a retrospective, cross-sectional, two-center study of patients diagnosed with AA between 1 January 2016 and 31 December 2023. The demographic and analytical variables were analyzed. The NLR was defined as the quotient between the absolute values of neutrophils and lymphocytes. Hyponatremia was defined as a serum Na level of ≤135 mmol/L. The sensitivity and specificity of the NLR and the serum Na level in the diagnosis of CAA were determined by assessing the receiver operating characteristic curves. : Among the patients who underwent an appendectomy, 3066 histologically confirmed AA cases were identified and included in this study. The registered data revealed that 348 (11.3%) patients had CAA, and the remaining 2718 (88.7%) patients had UCAA. The mean ages were 49.47 ± 18.97 and 38.16 ± 14.50, respectively ( < 0.001). The analysis revealed an exponential correlation between the NLR and the serum Na level with a moderate degree of agreement with CAA (Cohen's Kappa: 0.461, < 0.001). For CAA, using the NLR and the serum Na level, the areas under the curve and the cutoffs were 0.664, 4.2 with a confidence interval (CI) of 0.647-0.681 and 0.727, 135 mmol/L with a CI of 0.711-0.742, respectively; all these values were significant with a -value of <0.001. : Although the serum Na level is a more effective marker than the NLR, using these two variables together can help detect high-risk patients who may benefit from early management by limiting delays in surgery.
区分复杂型急性阑尾炎（CAA）和单纯型急性阑尾炎（UCAA）的最佳方法仍存在争议。本研究旨在探讨血清钠（Na）水平和中性粒细胞与淋巴细胞比值（NLR）在区分 CAA 和 UCAA 中的潜在应用，并评估这两个变量联合使用是否能更可靠地诊断 CAA。
这是一项回顾性、横断面、双中心研究，纳入了 2016 年 1 月 1 日至 2023 年 12 月 31 日期间被诊断为 AA 的患者。分析了人口统计学和分析变量。NLR 定义为中性粒细胞绝对值与淋巴细胞绝对值之比。低钠血症定义为血清 Na 水平≤135mmol/L。通过评估受试者工作特征曲线确定 NLR 和血清 Na 水平在诊断 CAA 中的灵敏度和特异性。
在接受阑尾切除术的患者中，共确定了 3066 例组织学证实的 AA 病例，并纳入本研究。登记数据显示，348 例（11.3%）患者为 CAA，其余 2718 例（88.7%）患者为 UCAA。平均年龄分别为 49.47±18.97 岁和 38.16±14.50 岁（<0.001）。分析显示，NLR 与血清 Na 水平之间存在指数相关性，与 CAA 有中度一致性（Cohen's Kappa：0.461，<0.001）。对于 CAA，使用 NLR 和血清 Na 水平，曲线下面积和截断值分别为 0.664、4.2（置信区间[CI]为 0.647-0.681）和 0.727、135mmol/L（CI 为 0.711-0.742），所有这些值均有统计学意义（P<0.001）。
尽管血清 Na 水平是比 NLR 更有效的标志物，但联合使用这两个变量可以帮助检测出高危患者，通过限制手术延迟，使这些患者可能从早期管理中受益。
