Objective To explore the relationship between blood inflammatory markers combined with abdominal computed tomography (CT) grading and pathological classification in the patient with acute appendicitis for early diagnosis of acute appendicitis. Methods The clinical data of 133 patients of acute appendicitis were retrospectively analyzed with blood inflammatory markers, abdominal CT scan and pathological classification. Results Pathological classification of patients including 14 cases with uncomplicated appendicitis, 108 cases with suppurative appendicitis and 11 cases with gangrenous or perforated appendicitis correlated abdominal CT grading significantly (R=0.374,P<0.001). Blood inflammatory markers, which were white blood cell (WBC) count, neutrophil percentage (N%), and CRP concentration, and appendiceal diameter from CT scan increased simultaneously. The indexes (WBC≥12.45×109/L,N%≥81.80%,CRP≥22.56 mg/L,and appendiceal diameter ≥8.75 mm) could help differentiation of uncomplicated acute appendicitis from gangrenous or perforated appendicitis. CRP concentration above cut-points 54.00 mg/L differentiated the diagnosis of patients with gangrenous or perforated appendicitis from suppurative or uncomplicated appendicitis. The patients with CT grade 1 were determined by any one of the indicators (WBC, N%, CRP and appendix diameter) exceeds the normal value. The patients with CT grade 2 presented elevation of both CRP and appendiceal diameter. The patients with CT grade 3 and 4 presented all elevation of WBC, N% and CRP levels. Conclusions Very high concentration levels of CRP in the patients with acute appendicitis might be useful for differential diagnose between gangrenous or perforated appendicitis and uncomplicated or suppurative appendicitis. Combined observation of WBC, N%, CRP or appendiceal diameter improves the accuracy of early diagnosis of acute appendicitis.
WANG Jian, PAN Xin, TANG Cui, MA Le, ZENG Siliang
. Acute appendicitis: relationship between blood inflammatory markers with CT grading and pathological classification[J]. Journal of Surgery Concepts & Practice, 2019
, 24(05)
: 458
-464
.
DOI: 10.16139/j.1007-9610.2019.05.017
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