Tıp Fakültesi / Faculty of Medicine

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    Receiver Operating Characteristic Analysis and Discriminative Effect of Neutrophil-To-Lymphocyte Ratio in Patients with Suspected Appendicitis
    (2016) Ozturk, S.; Unver, M.; Yoldas, O.; Dizen, H.; Erol, V.; Bozbiyik, O.; Guner, M.; Pehlivanoglu, K.; Kebapci, B.; Aydin, C.
    Introduction: Acute appendicitis (AA) is one of the most common causes of abdominal pain and emergent abdominal surgery. The incidence is approximately 10% during the lifetime. Although appendectomy is a most common surgical procedure worldwide, it's complication rate is 5-28% A delay in diagnosis of AA is associated with prolonged hospitalization, an increased rate of perforation (34%-75%), wound infection (0%-11%), pelvic abscess (1%-5%) and late intro-abdominal adhesions. Appendectomy is first described by McBurney in 1894 and still remains the standart procedure for AA. Although patients with AA often present with a characteristic symptom complex and physical findings, atypical presentations are common. The aim of this study was to assess the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) in patients who were operated for suspected acute appendicitis and to assess the discriminative effect of this ratio between wzinflamed, uncomplicated and complicated appendicitis. Materials and methods: The medical records of 3212 patients who underwent appendectomy for suspected acute appendicitis during a 10-year period were reviewed retrospectively. Patients were divided into 3 groups; group 1, 208 consecutive patients who had uninflamed appendix at appendectomy; group 2, 2111 consecutive patients who had uncomplicated acute appendicitis at appendectomy; group 3, 893 patients who had complicated appendicitis (perforated appendix or peri-appendicular abscess) at appendectomy. Data for three groups of patients were analyzed to calculate the sensitivity and specificity of the NLR in the diagnosis of acute appendicitis. Receivers operating characteristic (ROC) curves were used to evaluate this ratio in a relation with true diagnosis and severity of acute appendicitis. Results: 1792 (55.8%) of the patients were male and 1420 (44.2%) of them were female. The mean age of the groups were 30.28 +/- 14.18, 29.98 +/- 12.63 and 33.81 +/- 16.27 respectively. The discriminative effect of NLR was higher between uninflamed and complicated appendicitis groups with a cut-off value of 3,94. The recommended cut-off value of the preoperative NLR was decided using ROC curve analyses. The recommended cut-off value of the NLR was based on the most prominent point on the ROC curve for sensitivity (82.2%) and specificity (56.5%). The area under the ROC curve was 0.74. Conclusion: AA is one of the most common surgical emergencies and the most common source of infection in community acquired intra-abdominal infections. However the diagnosis is often challenging and the decision to operate, observe or further work-up on a patient is often unclear. Initial management of patients with suspected AA is based on the history of the patient, physical examination, basic laboratory tests reflecting the inflammatory response and radiologic imaging. NLR is a helpful biochemical parameter for the diagnosis of acute appendicitis but it has limited value on differentiating patients with complicated appendicitis from patients with uninflamed and uncomplicated appendicitis.
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    A New Approach To The Management Of Acute Appendicitis: Decision Tree Method
    (2022) Erkent, Murathan; Karakaya, Emre; Yucebas, Sait Can; https://orcid.org/0000-0002-3592-5092; 35152124; CAA-2756-2022
    Background: It is important to distinguish between complicated acute appendicitis (CAA) and noncomplicated acute appendicitis (NCAA) because the treatment methods are different. We aimed to create an algorithm that determines the severity of acute appendicitis (AA) without the need for imaging methods, using the decision tree method. Methods: The patients were analyzed retrospectively and divided into two groups as CAA and NCAA. Age, gender, Alvarado scores, white blood cell values (WBC), neutrophil/lymphocyte ratios (NLR), C-reactive protein value (CRP), albumin value and CRP/Albumin ratios of the patients were recorded. Results: In the algorithm we created, the most important parameter in the distinction between CAA and NCAA is CRP. NLR is predictive in patients with a CRP value of <= 107.565 mg/L, and the critical value is NLR 2.165. In pa-tients with a CRP value of >107.565 mg/L, albumin is the determinant and the critical value is 2.85 g/dL. Age, gen -der, alvarado score and CRP/albumin ratio have no significance in distinguishing between CAA and NCAA. In the statistical analysis, there were significant differences between NCAA and CAA groups in terms of age (39.56 years vs 13,675 years), gender (48.1% male vs 71.4% male), WBC (13,891.10/mL vs 11,614.76/mL), CRP (27 mg/L vs 127 mg/L), albumin (3 g/dL vs 3 g/dL) and CRP/albumin (9.50 vs. 41). Conclusion: Thanks to the algorithm we created, CAA and NCAA distinction can be made quickly. In addition, by avoiding unnecessary surgical procedures in NCAA cases, patients' quality of life can be increased and morbidity rates can be minimized.(c) 2022 Elsevier Inc. All rights reserved.