Time-Related Parameters in Acute Appendicitis

Abstract

Acute appendicitis is one of the most common causes of surgical interventions. Timely diagnosis is very important to avoid complicated appendicitis as the risk increases with time from onset of symptoms. The aim of this study was to correlate duration of symptoms and laboratory parameters with histopathological inflammation grade in acute appendicitis and to determine time values from onset of symptoms to appendiceal perforation and leucocyte and C-reactive protein values predictive for perforated appendix (PA). A total of 388 patients who underwent appendectomy for acute appendicitis were involved in retrospective, single-center study. Time of onset of pain, time of first medical examination, time of surgery, C-reactive protein (CRP), and leucocyte count (L) were recorded and correlated with histopathological findings of appendix categorized as erythematous, purulent, necrotic, and perforated. Younger patients (0–39 years) generally presented with lower histopathological grade than older patients (≥ 40 years) and were more likely to report to medical institution earlier after the onset of symptoms (median 18.2 h vs. 27.1 h). More severe histopathological grade is related to longer time passed between onset of symptoms and first medical examination and surgery. ROC analysis showed that time of 53.6 h between onset of symptoms and surgery had acceptable discriminatory value for development of perforated appendix in adults and 52.97 h in pediatric patients (≤ 18 years). In adult patients (≥ 18 years), ROC analysis showed that CRP value of 88.5 mg/L was found to be predictive for perforated appendix. In pediatric patients, there was no statistically significant cut-off value of CRP for PA. Leucocyte count did not show significant predictive value for PA. Time from first medical exam to surgery did not significantly correlate with any of the variables. Timely diagnosis is of great importance to avoid perforated appendix as time of 53 h from onset of symptoms to surgery shows acceptable discriminatory value between necrotic and perforated appendix, especially in pediatric patients. Different histopathological grades of appendicitis showed statistically significant difference between leucocytes and C-reactive protein values. CRP value of 88.5 mg/L was found to be predictive for PA in adults.