Haydarpasa Numune Med J. 2019; 59(1): 35-40 | DOI: 10.14744/hnhj.2019.16013

Predictive Value of Serum Sodium Level in Determining Complicated Appendicitis Risk in Children

Gulser Esen Besli¹, Merve Cetin², Cigdem Ulukaya Durakbasa³, Seyma Ozkanli^4
1Department of Pediatric Emergency, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
²Department of Pediatrics, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
³Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
⁴Department of Patology, Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey

INTRODUCTION: Acute appendicitis is one of the most common surgical emergencies in childhood. Early recognition and treatment of children with complicated appendicitis, especially perforated and gangrenous, is very crucial. The aim of the present study was to determine the predictive value of simple blood tests, such as serum sodium (Na) level, C-reactive protein (CRP) level, and blood leukocyte and neutrophil counts, in complicated appendicitis.
METHODS: A total of 403 patients who underwent operation with the initial diagnosis of acute appendicitis that was confirmed by surgery and histopathology were evaluated retrospectively. Patients with perforated or gangrenous appendix, generalized peritonitis, and intra-abdominal abscess were identified as complicated appendicitis. Basal serum Na and CRP levels and blood leukocyte and neutrophil counts of patients with complicated and non-complicated appendicitis were compared.
RESULTS: Of the 403 patients, 158 (39.2%) had non-complicated, and 245 (60.8%) had complicated appendicitis. No difference was found between the two groups with regard to hyponatremia, leukocytosis, and neutrophilia (p>0.05). The risk of complicated appendicitis increased 2.5-fold in patients with elevated CRP (odds ratio: 2.498; 95% confidence interval: 1.558–4.004). Patients with complicated appendicitis had lower baseline serum Na levels (p=0.004; p<0.05). For diagnosis of complicated appendicitis, the cut-off value for Na was ≤138 mEq/L (sensitivity 82.5% and specificity 31.1%).
DISCUSSION AND CONCLUSION: It was concluded that blood leukocyte and neutrophil counts in patients with suspected acute appendicitis in the emergency department were not helpful in determining the risk of complicated appendicitis. Although a basal serum Na level ≤138 mEq/L has a high sensitivity in predicting complicated appendicitis, its specificity is low.

Keywords: Children, complicated appendicitis; c-reactive protein; hyponatremia; leukocyte; neutrophil.

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Çocuklarda komplike apandisit riskini belirlemede serum sodyum düzeyinin prediktif deðeri

Gulser Esen Besli¹, Merve Cetin², Cigdem Ulukaya Durakbasa³, Seyma Ozkanli^4
1Istanbul Medeniyet Üniversitesi Göztepe Eðitim Ve Araþtýrma Hastanesi, Çocuk Acil Ünitesi, Göztepe, Istanbul.
²Istanbul Medeniyet Üniversitesi Göztepe Eðitim Ve Araþtýrma Hastanesi, Çocuk Saðlýðý Ve Hastalýklarý Ana Bilim Dalý, Göztepe, Istanbul.
³Istanbul Medeniyet Üniversitesi Týp Fakültesi Göztepe Eðitim Ve Araþtýrma Hastanesi, Çocuk Cerrahisi Ana Bilim Dalý, Göztepe, Istanbul.
⁴Istanbul Medeniyet Üniversitesi Týp Fakültesi Göztepe Eðitim Ve Araþtýrma Hastanesi, Patoloji Ana Bilim Dalý, Göztepe, Istanbul.

GÝRÝÞ ve AMAÇ: Akut apandisit çocukluk çaðýnda en sýk karþýlaþýlan acil cerrahi durumlardan biridir. Özellikle perfore, gangrenöz gibi komplike apandisit olgularýnýn erken tanýnmasý ve tedavi edilmesi çok önemlidir. Bu çalýþmada komplike apandisit için serum sodyum (Na) düzeyi baþta olmak üzere, CRP (C-reaktif protein) düzeyi, kan lökosit ve nötrofil sayýmý gibi basit kan testlerinin prediktif deðerinin belirlenmesi amaçlandý.

YÖNTEM ve GEREÇLER: Hastanemizde akut apandisit ön tanýsý ile opere edilip, histopatolojik ve cerrahi olarak apandisit tanýsý doðrulanmýþ olan 403 hasta retrospektif olarak deðerlendirildi. Perfore ya da gangrenöz apendix, generalize peritonit, batýn içi abse saptanan hastalar komplike apandisit olarak deðerlendirildi. Komplike ve non-komplike apandisitli hastalarýn bazal serum Na ve CRP düzeyleri, kan lökosit ve nötrofil sayýlarý karþýlaþtýrýldý.
BULGULAR: 403 hastanýn 158’i (%39,2) non-komplike, 245’i (%60,8) komplike apandisit idi. Ýki grup arasýnda hiponatremi, lökositoz ve nötrofili açýsýndan fark saptanmadý (p>0,05). CRP yüksekliði olan hastalarda komplike apandisit riskinin 2,5 kat arttýðý belirlendi (OR: 2,498; %95 Güven Aralýðý: 1,558-4,004). Komplike apandisitli hastalarýn bazal serum Na düzeyi daha düþüktü (p: 0,004, p<0,05). Komplike apandisit tanýsýnda Na için sýnýr deðeri ≤138 mEq/L olarak bulundu (duyarlýlýk %82,5, seçicilik %31,1).
TARTIÞMA ve SONUÇ: Acil serviste akut apandisit ön tanýsý ile izlenen hastalarda kan lökosit ve nötrofil sayýsýnýn, komplike apandisit riskini belirlemede yol gösterici olmadýðý sonucuna varýldý. Bazal serum Na düzeyinin ≤138 mEq/l olmasý, komplike apandisiti öngörmede duyarlýlýðý yüksek olmakla birlikte seçiciliði düþük bir belirteçtir.

Anahtar Kelimeler: Çocuk, komplike apandisit, hiponatremi, C-reaktif protein, lökosit, nötrofil

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