Published online Jun 6, 2020. doi: 10.12998/wjcc.v8.i11.2127
Peer-review started: February 13, 2020
First decision: April 1, 2020
Revised: April 8, 2020
Accepted: May 13, 2020
Article in press: May 13, 2020
Published online: June 6, 2020
Because evidence on conservative treatment of acute appendicitis has increased, differentiation of patients with complicated appendicitis (CA) from those with simple appendicitis (SA) has become increasingly important. Previous studies have revealed that male gender, advanced age, comorbid conditions, prehospital delay, fever, and anorexia are risk factors of perforated appendicitis. Elevated serum C-reactive protein (CRP) level and hyponatremia have also been reported as predictive biomarkers of CA.
Confounding between various factors is problematic because most previous studies were univariate analyses. Thus, we performed a study using logistic regression analyses.
The objective of the study was to evaluate non-laboratory and laboratory predictive factors of CA using logistic regression analyses using logistic regression analyses.
We performed a single-center, retrospective case-control study that evaluated 198 patients (83.9%) with SA and 38 patients (16.1%) with CA. Diagnoses were confirmed by computed tomography images for all cases. We compared age, sex, clinical symptoms, past medical history, vital signs, physical findings, and laboratory data. Based on the comparisons, we performed logistic regression for clinical differentiation between CA and SA using only non-laboratory factors and also including both non-laboratory and laboratory factors.
The 236 eligible patients consisted of 198 patients (83.9%) with SA and 38 patients (16.1%) with CA. The median ages were 34 years old in the SA group and 49 years old in the CA group. The median onset-to-visit interval was 1 d and 1 d in the SA and CA groups, respectively. Heart rate, body temperature, and serum CRP level in the CA group were significantly higher than in the SA group; glomerular filtration rate (GFR) and serum sodium were significantly lower in the CA group. Anorexia was significantly more prevalent in the CA group. The regression model including age, onset-to-visit interval, anorexia, tachycardia, and fever as non-laboratory predictive factors of CA (Model 1) showed that age ≥ 65 years old, longer onset-to-visit interval, and anorexia had significantly high odds ratios. The logistic regression for prediction of CA including age, onset-to-visit interval, anorexia, serum CRP level, hyponatremia, and glomerular filtration rate < 60 mL/min/1.73 m2 (Model 2) showed that only elevated CRP levels had significantly high odds ratios.
Our logistic regression analysis on differentiating factors of CA from SA showed that high CRP level was a strong dose-dependent predictor of CA.