[Comparación del índice de neutrófilos/linfocitos, la escala de SOFA y la concentración sérica de procalcitonina como indicadores de la gravedad de la apendicitis aguda].

Introducción

La apendicitis aguda (AA) es una de las principales causas de abdomen agudo. Un retraso en su diagnóstico y tratamiento elevan la morbimortalidad.

Objetivo

Evaluar el índice de neutrófilos/linfocitos (INL), la escala SOFA (Sequential Organ Failure Assessment), la procalcitonina (PCT) y la bilirrubina total (BT), y ver si existe relación como determinantes de la gravedad de la AA.

Método

Estudio retrospectivo, observacional, para comparar el INL contra biomarcadores (PCT, BT) y contra escalas de gravedad (APACHE II [Acute Physiology and Chronic Health Evaluation] y SOFA) y quirúrgica (Mannheim).

Resultados

82 casos de enero a mayo de 2017. El 80.8% de los casos con peritonitis generalizada presentaron un INL > 12 (p = 0.002). El 66% de los casos con perforación apendicular presentaban un INL > 12 (p = 0.024). El 70% de los casos graves por BT mostraron un INL > 12 (p = 0.004). El 75% de los casos graves por PCT presentaban un INL > 12 (p = 0.006). El 50% de los casos con SOFA > 6 mostraron un INL > 12 (U de Mann-Whitney, p = 0.023).

Conclusión

Existe una relación entre el INL tanto con SOFA, BT y PCT, lo cual indica que un INL > 12 puntos podría estar relacionado con peritonitis generalizada y apendicitis perforada.

Background

Acute appendicitis (AA) is one of the main causes of acute abdomen that requires urgent surgical treatment, a delay in its diagnosis and therapeutic increase in morbidity and mortality.

Objective

To evaluate the usefulness of inflammatory markers as a tool to compare the neutrophil/lymphocyte ratio (NLR), the SOFA scale (Sequential Organ Failure Assessment) and the serum level of procalcitonin, total bilirubin, and see if there is a relationship as indicators and determinants of the severity of AA.

Method

An retrospective, observational, and analytical study to evaluate the usefulness of the NLR as a diagnostic and severity indicator of AA, comparing it against biomarkers (BT and PCT), and against two severity scales ­(APACHE II [Acute Physiology and Chronic Health Evaluation] and SOFA) and a surgical scale (Mannheim).

Results

We included 82 cases from January to May 2017. 80.8% of those cases with generalized peritonitis had an NLR > 12 (p = 0.002). 66% of the cases with appendiceal perforation presented an NLR > 12 (p = 0.024). 70% of severe cases due to TB showed an NLR > 12 (p = 0.004). 75% of severe cases due to PCT have an NLR > 12 (p = 0.006). 50% of the cases with SOFA > 6 showed an NLR > 12 (U Mann-Whitney, p = 0.023).

Conclusions

There is a relationship between the NLR with SOFA, total bilirubin and procalcitonin, indicating that an NLR > 12 points could be related to generalized peritonitis and perforated appendicitis.

Informations de copyright

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