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01-11-2014 | Original Scientific Report

Can New Inflammatory Markers Improve the Diagnosis of Acute Appendicitis?

Authors: Manne Andersson, Marie Rubér, Christina Ekerfelt, Hanna Björnsson Hallgren, Gunnar Olaison, Roland E. Andersson

Published in: World Journal of Surgery | Issue 11/2014

Abstract

Background

The diagnosis of appendicitis is difficult and resource consuming. New inflammatory markers have been proposed for the diagnosis of appendicitis, but their utility in combination with traditional diagnostic variables has not been tested. Our objective is to explore the potential of new inflammatory markers for improving the diagnosis of appendicitis.

Methods

The diagnostic properties of the six most promising out of 21 new inflammatory markers (interleukin [IL]-6, chemokine ligand [CXCL]-8, chemokine C–C motif ligand [CCL]-2, serum amyloid A [SAA], matrix metalloproteinase [MMP]-9, and myeloperoxidase [MPO]) were compared with traditional diagnostic variables included in the Appendicitis Inflammatory Response (AIR) score (right iliac fossa pain, vomiting, rebound tenderness, guarding, white blood cell [WBC] count, proportion neutrophils, C-reactive protein and body temperature) in 432 patients with suspected appendicitis by uni- and multivariable regression models.

Results

Of the new inflammatory variables, SAA, MPO, and MMP9 were the strongest discriminators for all appendicitis (receiver operating characteristics [ROC] 0.71) and SAA was the strongest discriminator for advanced appendicitis (ROC 0.80) compared with defence or rebound tenderness, which were the strongest traditional discriminators for all appendicitis (ROC 0.84) and the WBC count for advanced appendicitis (ROC 0.89). CCL2 was the strongest independent discriminator beside the AIR score variables in a multivariable model. The AIR score had an ROC area of 0.91 and could correctly classify 58.3 % of the patients, with an accuracy of 92.9 %. This was not improved by inclusion of the new inflammatory markers.

Conclusion

The conventional diagnostic variables for appendicitis, as combined in the AIR score, is an efficient screening instrument for classifying patients as low-, indeterminate-, or high-risk for appendicitis. The addition of the new inflammatory variables did not improve diagnostic performance further.

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Title: Can New Inflammatory Markers Improve the Diagnosis of Acute Appendicitis?
Authors: Manne Andersson
Marie Rubér
Christina Ekerfelt
Hanna Björnsson Hallgren
Gunnar Olaison
Roland E. Andersson
Publication date: 01-11-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 11/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2708-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Can New Inflammatory Markers Improve the Diagnosis of Acute Appendicitis?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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