| Abstract | Cilj istraživanja: Cilj ovog istraživanja bio je istražiti hiperbilirubinemiju kao pouzdanog laboratorijskog pretkazatelja perforacije akutnog apendicitisa u djece.
Ispitanici i metode: U prospektivnu kohortnu studiju uključena su ukupno 284 ispitanika koji su imali patohistološki potvrđen akutni apendicitis. Anamneza, demografski i klinički podatci zabilježeni su u protokolu studije. Prije operacije uzeti su uzorci krvi za određivanje akutnih upalnih parametara i vrijednosti bilirubina. S ozbirom na intraoperacijske nalaze bolesnici su podijeljeni u dvije skupine, perforirani akutni apendicitis (n=64; 22,5%) i neperforirani akutni apendicitis (n=220; 77,5%). Primarni ishod bila je dijagnostička točnost razine bilirubina u razlikovanju jednostavnog od perforiranog akutnog apendicitisa.
Rezultati: Medijan bilirubina u bolesnika s perforiranim akutnim apendicitisom bio je značajno viši u odnosu na bolesnike s neperforiranim akutnim apendicitisom (27 µmol/L nasuprot 10 µmol/L, P<0,001). Karakteristična krivulja primatelja-operatora (ROC) ukupne razine bilirubina u serumu bolesnika s perforiranim akutnim apendicitisom pokazala je produčje ispod krivulje (AUC) vrijednosti 0,876 (95% CI, 0,820 – 0,929). Pokazalo se da granična vrijednost ukupnog bilirubina u serumu vrijednosti 15,5 µmol/L daje najbolju moguću osjetljivost i specifičnost od 92% i 77,3%. Hiperbilirubinemija pri prijamu pronađena je u 35 bolesnika (54,7%) koji su imali perforirani akutni apendicitis i u 14 (6,4%) bolesnika s neperforiranim akutnim apendicitisom (P<0,001). Modeliranjem prikupljenih podataka bivarijantnom logističkom regresijom utvrđeno je da su koncentracija bilirubina u serumu (OR=1,12; 95% CI 1,07 – 1,18; P<0,001), koncentracija natrija u serumu (OR=0,64; 95% CI, 0,51 – 0,81; P<0,001), povišena tjelesna temperatura (OR=2,48; 95% CI 1,05 – 0,84; P<0,001) i trajanje simptoma (OR=1,06; 95% CI; 1,02 – 1,09; P<0,001) pouzdani prediktivni faktori za perforirani akutni apendicitis.
Zaključak: Povišena razina ukupnog bilirubina u serumu može biti pouzdan prediktor perforiranog akutnog apendicitisa u djece. Razina ukupnog bilirubina jeftina je, jednostavna i dostupna laboratorijska pretraga i sukladno tomu treba ju preporučiti u početnoj procjeni akutnog apendicitisa u djece. |
| Abstract (english) | Objectives: The aim of this study was to investigate hyperbilirubinemia as a reliable laboratory marker associated with perforated appendicitis in children.
Patients and methods: A total number of 284 patients with acute appendicitis confirmed by histopathology were enrolled in a prospective cohort study. Medical history, demographic and clinical data were recorded in the study protocol. Blood samples for acute inflammatory markers and bilirubin were taken prior to surgery. Regarding intraoperative findings, the patients were divided in two groups, perforated appendicitis (n=64; 22.5%) and simple appendicitis (n=220; 77.5%). The primary outcome was the diagnostic accuracy of serum bilirubin levels in discriminating between simple and perforated appendicitis.
Results: The median serum bilirubin level in patients with perforated appendicitis was significantly higher compared to the patients with non-perforated appendicitis (27 μmol/L vs. 10 μmol/L, P <0.001). The receiver operating characteristic curve of total serum bilirubin level in patients who were diagnosed with perforated acute appendicitis showed an area under the curve of 0.876 (95% CI, 0.820 – 0.929). A cut-off-value of total serum bilirubin concentration of 15.5 μmol/L was shown to give the best possible sensitivity and specificity, 92% and 77.3% respectively (P<0.001). Hyperbilirubinemia at admission was found in 35 patients (54.7%) with complicated appendicitis and in 14 patients (6.4%) with non-perforated appendicitis (P<0.001). The modeling of collected data by bivariate logistic regression identified serum bilirubin concentration (OR=1.12; 95% CI 1.07 – 1.18; P<0.001), serum sodium concentration (OR=0.64; 95% CI, 0.51 – 0.81; P<0.001), body temperature (OR=2.48; 95% CI 1.05 – 0.84; P<0.001) and duration of symptoms (OR=1.06; 95% CI; 1.02 – 1.09; P<0.001) as risk factors for complicated appendicitis.
Conclusion: Elevated level of total serum bilirubin may be useful association of the perforated appendicitis in children. Serum bilirubin level is cheap, simple and available laboratory test and should therefore be recommended in initial evaluation for acute appendicitis in children. |
