Authors: Manne Andersson Marie Rubér Christina Ekerfelt Hanna Björnsson Hallgren Gunnar Olaison Roland E Andersson
Publish Date: 2014/08/07
Volume: 38, Issue: 11, Pages: 2777-2783
Abstract
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 appendicitisThe diagnostic properties of the six most promising out of 21 new inflammatory markers interleukin IL6 chemokine ligand CXCL8 chemokine C–C motif ligand CCL2 serum amyloid A SAA matrix metalloproteinase MMP9 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 Creactive protein and body temperature in 432 patients with suspected appendicitis by uni and multivariable regression modelsOf the new inflammatory variables SAA MPO and MMP9 were the strongest discriminators for all appendicitis receiver operating characteristics ROC 071 and SAA was the strongest discriminator for advanced appendicitis ROC 080 compared with defence or rebound tenderness which were the strongest traditional discriminators for all appendicitis ROC 084 and the WBC count for advanced appendicitis ROC 089 CCL2 was the strongest independent discriminator beside the AIR score variables in a multivariable model The AIR score had an ROC area of 091 and could correctly classify 583 of the patients with an accuracy of 929 This was not improved by inclusion of the new inflammatory markersThe conventional diagnostic variables for appendicitis as combined in the AIR score is an efficient screening instrument for classifying patients as low indeterminate or highrisk for appendicitis The addition of the new inflammatory variables did not improve diagnostic performance further
Keywords: