CRP INDEPENDENTLY PREDICTS FAILURE OF ANTIBIOTIC NON-OPERATIVE MANAGEMENT OF EARLY UNCOMPLICATED ACUTE APPENDICITIS IN ADULTS.
Asri Che JUSOH, Syahmi ABDUL GHANI, Ikram ISHAK, Faiz Najmuddin GHAZI
Department of general surgery, Kuala Krai Hospital, 18000 Kuala Krai, Kelantan, Malaysia
Aim: The main objective was to determine parameters that could predict failure of antibiotic non-operative management (ANOM) for early uncomplicated acute appendicitis (EUAA). Methods: This was a retrospective study of all cases admitted for suspected acute appendicitis (AA) from January to December 2016. Demographic data, appendicitis related score such as ALVARADO, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Score, Appendicitis Inflammatory Response score (AIR), Neutrophil lymphyocyte ratio (NLR) and other clinical parameters such as age and C-reactive protein (CRP) were analysed. All the scores and laboratory parameters were taken only once during admission. Results: One hundred and twelve patients suspected of AA were identified. Twenty-six (n=26) patients were operated for complicated AA but 60% (n=65) were offered ANOM. Only 16 patients of the latter group failed (25%) ANOM therapy and underwent appendicectomy. Using multivariate logistic regression analysis, only CRP at time of admission was an independent and a significant predictor for failure of ANOM (adjusted OR 1.02, CI 1.007-1.032, p=0.002). The area under the receiver operating characteristics curve for CRP was 0.77 (p=0.004; CI: 0.613 – 0.937). CRP ≥ 18 mg/L has sensitivity, specificity, positive predictive value and negative predictive value of 99%, 39.5%, 34.3% and 99% respectively, p=0.009 for predicting failure of ANOM. Conclusion: Majority cases of AA can be successfully managed with ANOM, with good outcome but its failure can be predicted by an admission CRP level of ≥ 18 mg/L.
KEYWORDS: Acute Appendicitis, ALVARADO score, Appendicitis Inflammatory Response (AIR) score, C-Reactive Protein, Non-Operative Management, RIPASA score.
Correspondence: Asri Che Jusoh MBBS, MS (surgery), consultant general surgeon, department of general surgery, Kuala Krai Hospital, 18000 kuala krai, Kelantan, Malaysia.
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Brunei Int Med J. 2018;14:130-139