| Abstract | Cilj istraživanja: Cilj ove studije bio je istražiti hiponatrijemiju kao novi laboratorijski prediktor povezan s kompliciranom upalom crvuljka u djece.
Ispitanici i metode: U razdoblju od siječnja 2019. do svibnja 2020. u prospektivnu kohortnu studiju uključena su 184 pedijatrijska bolesnika s akutnom upalom crvuljka, koja je potvrđena histopatološkim metodama. Anamneza, demografski i klinički podaci zabilježeni su u protokolu studije. Svakom ispitaniku uključenom u studiju prije operacije su uzeti uzorci krvi za laboratorijsku analizu elektrolita i upalnih parametara. Obzirom na operacijski nalaz, bolesnici su podijeljeni u dvije skupine: neperforirana upala crvuljka (n=148; 79%) i perforirana upala crvuljka (n=38; 21%).
Rezultati: Prosječna koncentracija natrija u serumu bolesnika s kompliciranom upalom crvuljka bila je značajno niža u usporedbi s bolesnicima s nekompliciranom upalom (132,2 mmol/L u odnosu na 139,2 mmol/L, P <0,001). Krivulja karakteristika primatelja-operatora (ROC) koncentracije natrija u bolesnika kojima je dijagnosticiran perforirani apendicitis pokazala je područje ispod krivulje od 0,983 (95% CI: 0,963-1,00). Vrijednost koncentracije natrija u plazmi ≤135 mmol/L pokazala je najbolju moguću osjetljivost od 94,7% (95% CI: 82,2-99,3) i specifičnost od 88,5% (95% CI: 88,2-93,2) (P<0,001). Univarijantna logistička regresija pokazla je da bolesnici s perforiranim apendicitisom imaju značajno veću vjerojatnost da su mlađi od pet godina (10,5% nasuprot 1,4%; P=0,005), da im je duljina trajanja simptoma >24 h (97,4% nasuprot 59,6%; P<0,001), koncentracija natrija u serumu ≤135 mmol/L (89,5% nasuprot 5,5%; P<0,001), tjelesna temperatura >38,5 ˚C (47,4% u odnosu na 11,0%; P<0,001) i koncentracije CRP-a u serumu >62 mg/L (26% prema 2%; P<0,001).
Zaključci: Hiponatrijemija je utvrđena kao jak i nov pokazatelj kompliciranog apendicitisa u pedijatrijskoj populaciji. Ovaj nalaz može biti od velike pomoći specijalistima dječje kirurgije prilikom donošenja odluka o liječenju akutne upale crvuljka u djece. |
| Abstract (english) | Objectives: The aim of this study was to investigate hyponatremia as a new laboratory marker associated with complicated appendicitis in pediatric population.
Patients and methods: In the period from January 2019 to May 2020, 184 pediatric patients with acute appendicitis confirmed by histopathology were enrolled in prospective cohort study. Medical history, demographic and clinical data were recorded in study protocol. Prior to surgery, from each patient blood samples were taken for laboratory analysis of electrolytes and acute inflammatory markers. In regards to the intraoperative finding the patients were divided in two groups: non-perforated (n=148; 79%) and perforated appendicitis (n=38; 21%).
Results: The mean serum sodium level in patients with complicated appendicitis was significantly lower compared to the patients with non-complicated appendicitis (132.2 mmol/L vs. 139.2 mmol/L, P<0.001). The receiver operating characteristic curve of plasma sodium concentration in patients who were diagnosed with perforated acute appendicitis showed an area under the curve of 0.983 (95% CI, 0.963-1.00). A cut-off-value of plasma sodium concentration of ≤135 mmol/L was shown to give the best possible sensitivity and specificity, 94.7% (95% CI: 82.2-99.3) and 88.5% (95% CI: 88.2-93.2) respectively (P<0.001). Regarding to the univariate logistic regression of relevant clinical cut-offs the patients with perforated appendicitis were more likely to be younger than five years of age (10.5% vs. 1.4%, P=0.005), have duration of symptoms for >24 h (97.4% vs. 59.6%, P<0.001), sodium serum concentration ≤135 mmol/L (89.5% vs. 5.5%, P<0.001), body temperature >38.5 ˚C (47.4% vs. 11.0%, P<0.001) and CRP serum concentration >62 mg/L (26% vs. 2%, P<0.001).
Conclusion: Hyponatremia has been found as a strong and novel marker of complicated appendicitis in pediatric population. This finding may be of great help to the pediatric surgeons in decision making regarding treatment management of acute appendicitis in children. |
