DIAGNOSTIC VALUE OF SERUM UREA, CREATININE, SODIUM AND POTASSIUM FOR COMPLICATED APPENDICITIS - A ONE YEAR RETROSPECTIVE STUDY
Keywords:Appendicitis, complicated appendicitis, diagnostic value, renal function tests, electrolytes
AbstractBackground: Acute appendicitis is a common surgical emergency and if complicated, manifesting as abscess, perforation, suppurative or gangrenous appendicitis, carries significant morbidity and mortality. Its early preoperative diagnosis can improve outcome in patients and reduce incidence of negative appendectomies. It, however, mandates identification of new diagnostic parameters for it. This retrospective study evaluates diagnostic accuracy of serum urea, creatinine, sodium and potassium for complicated appendicitis. Methods: 60 patients with suspected appendicitis were grouped into complicated and uncomplicated appendicitis based on histological reports. Preoperative laboratory results for serum urea, creatinine, sodium and potassium levels were obtained from hospital records. Diagnostic strength of these markers was calculated as specificity, sensitivity and area under curve. ROC curve analysis was used for their diagnostic accuracy. Results: The levels of serum urea, creatinine and K were not significantly different in uncomplicated and complicated appendicitis. However, sodium was significantly higher in complicated appendicitis. ROC curve analysis showed AUC values for all the studied variables to be greater than 0.5. However, none of the markers had good capability to differentiate complicated appendicitis from uncomplicated appendicitis. Conclusion: Serum urea, creatinine, sodium and potassium levels have shown a tendency to be predictive of complicated appendicitis but a strong association could not have been established. Hence, further investigation is warranted
Kim T, Cho B, Jung J, Lee M, Jang J, Kim C. Predictive Factors to Distinguish Between Patients with Noncomplicated Appendicitis and Those with Complicated Appendicitis. Ann Coloproctol 2015;31(5):192–7.
Snyder MJ, Guthrie M, Cagle SD. Acute appendicitis: efficient diagnosis and management. Am Fam Physician 2018;98(1):25–33.
Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 2020;15(1):27.
Khan M, Siddiqui M, Shahzad N, Haider A, Chaudhry M, Alvi R. Factors Associated with Complicated Appendicitis: View from a Low-middle Income Country. Cureus 2019;11(5):e4765.
Eddama M, Fragkos K, Renshaw S, Aldridge M, Bough G, Bonthala L et al. Logistic regression model to predict acute uncomplicated and complicated appendicitis. Ann R Coll Surg Engl 2019;101(2):107–18.
Lee H, Woo J, Byun J. Right hydronephrosis as a sign of complicated appendicitis. Eur J Radiol 2020;131:109241.
Emektar E, Dağar S, Karaatlı RH, Uzunosmanoğlu H, Buluş H. Determination of factors associated with perforation in patients with geriatric acute appendicitis. Turkish J Trauma Emerg Surg 2020;28(1):33–8.
Lietzén E, Mällinen J, Grönroos J, Rautio T, Paajanen H, Nordström P, et al. Is preoperative distinction between complicated and uncomplicated acute appendicitis feasible without imaging? Surgery 2016;160(3):789–95.
Giannis D, Matenoglou E, Moris D. Hyponatremia as a marker of complicated appendicitis: A systematic review. Surgeon 2020;18(5):295–304.
Kim D, Nassiri N, de Virgilio C, Ferebee M, Kaji A, Hamilton C, et al. Association Between Hyponatremia and Complicated Appendicitis. JAMA Surg 2015;150(9):911–2.
Pal KM, Khan A. Appendicitis: a continuing challenge. J Pak Med Assoc 1998;48(7):189–92.
Avanesov M, Wiese N, Karul M, Guerreiro H, Keller S, Busch P, et al. Diagnostic prediction of complicated appendicitis by combined clinical and radiological appendicitis severity index (APSI). Eur Radiol 2018;28(9):3601–10.
Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis. Am J Surg 2020;219(1):154–63.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.