Torun Mehmet, Subaşı İsmail Ege, Özbay Deniz Kol, Özbay Mehmet Ali, Özdemir Hakan
Gastrointestinal Surgery Clinic, University of Health Sciences, Kosuyolu Yuksek Ihtisas Research and Training Hospital, Istanbul, Turkey.
General Surgery Clinic, University of Health Sciences, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey.
Sci Rep. 2025 Feb 20;15(1):6177. doi: 10.1038/s41598-025-90591-2.
Acute appendicitis is a common condition requiring surgical intervention, with a lifetime risk of 7-8%. Differentiating between uncomplicated and complicated appendicitis is essential for appropriate treatment and improved patient outcomes. This study aimed to utilize minimal, non-invasive data to distinguish between these forms of appendicitis, using advanced analytical methods for faster and more precise diagnosis. This retrospective study analyzed acute appendicitis cases from January 2018 to December 2022 at a tertiary care hospital. Data were gathered from 3,045 patients, including demographic details, clinical features, laboratory tests (Red Cell Distribution Width [RDW] and Mean Platelet Volume [MPV]), and imaging results. Patients were classified as having uncomplicated or complicated appendicitis based on surgical and histopathological findings. Statistical analyses, including multivariate logistic regression and ROC curve analyses, were performed using SPSS. Complicated appendicitis was defined based on surgical findings and histopathological criteria, including perforation, abscess formation, or gangrene. Uncomplicated appendicitis was defined as inflammation confined to the appendix without evidence of perforation or abscess. The study population comprised 1,869 males (61.37%) and 1,176 females (38.62%), with a mean age of 36.4 years. The mean RDW was 27.81%, and the mean MPV was 8.68 fL. Among the appendectomy cases, 50.7% were acute appendicitis, 10.3% were negative appendectomies, and 38.9% had complicated appendicitis. RDW was significantly higher in acute appendicitis than in negative cases (t = 2.45, p = 0.02) and even higher in complicated cases (t = 3.78, p = 0.001). MPV was highest in complicated appendicitis, consistent with increased inflammation severity (t = 2.56, p = 0.01). The sensitivity and specificity of RDW for identifying complicated appendicitis were 0.85 and 0.75, respectively, and for MPV, they were 0.80 and 0.70. Univariate logistic regression identified male sex and appendix diameter as significant predictors of complicated appendicitis. In multivariate analysis, appendix diameter remained significant (p = 0.01), and male sex approached significance (p = 0.06). The optimal cutoff for appendix diameter to differentiate appendicitis types was 10 mm, with an AUC of 0.82. RDW, MPV, and appendix diameter provide a reliable method for distinguishing between uncomplicated and complicated appendicitis. Combining these biomarkers enhances diagnostic accuracy and enables precise risk stratification for better patient management.
急性阑尾炎是一种常见疾病，需要手术干预，终生患病风险为7%-8%。区分单纯性阑尾炎和复杂性阑尾炎对于恰当治疗及改善患者预后至关重要。本研究旨在利用最少的非侵入性数据来区分这两种阑尾炎形式，采用先进分析方法以实现更快、更精确的诊断。这项回顾性研究分析了一家三级医疗医院2018年1月至2022年12月期间的急性阑尾炎病例。收集了3045例患者的数据，包括人口统计学细节、临床特征、实验室检查（红细胞分布宽度[RDW]和平均血小板体积[MPV]）以及影像学结果。根据手术和组织病理学检查结果将患者分为单纯性或复杂性阑尾炎。使用SPSS进行了包括多变量逻辑回归和ROC曲线分析在内的统计分析。复杂性阑尾炎根据手术结果和组织病理学标准定义，包括穿孔、脓肿形成或坏疽。单纯性阑尾炎定义为炎症局限于阑尾，无穿孔或脓肿迹象。研究人群包括1869名男性（61.37%）和1176名女性（38.62%），平均年龄为36.4岁。平均RDW为27.81%，平均MPV为8.68飞升。在阑尾切除病例中，50.7%为急性阑尾炎，10.3%为阴性阑尾切除术，38.9%为复杂性阑尾炎。急性阑尾炎患者的RDW显著高于阴性病例（t = 2.45，p = 0.02），在复杂性病例中更高（t = 3.78，p = 0.001）。MPV在复杂性阑尾炎中最高，与炎症严重程度增加一致（t = 2.56，p = 0.01）。RDW识别复杂性阑尾炎的敏感性和特异性分别为0.85和0.75，MPV的敏感性和特异性分别为0.80和0.70。单变量逻辑回归确定男性性别和阑尾直径是复杂性阑尾炎的重要预测因素。在多变量分析中，阑尾直径仍然具有显著性（p = 0.01），男性性别接近显著性（p = 0.06）。区分阑尾炎类型的阑尾直径最佳截断值为10毫米，曲线下面积（AUC）为0.82。RDW、MPV和阑尾直径为区分单纯性和复杂性阑尾炎提供了一种可靠方法。结合这些生物标志物可提高诊断准确性，并实现精确的风险分层，以更好地管理患者。
