C-Reactive Protein, International Normalized Ratio, and Fibrinogen in Diagnostic Scale of Complicated Acute Appendicitis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants, Variables, and Study Design
2.2. Statistical Analysis
2.3. Construction of the Score
3. Results
3.1. Comparison of Preoperative Factors Between Complicated and Uncomplicated Acute Appendicitis
3.2. Factors Associated with Complicated Acute Appendicitis
3.3. Plasma Concentrations of C-Reactive Protein, Fibrinogen, and INR Are Individual Factors Associated with CA
3.4. Diagnostic Scale for Complicated Acute Appendicitis
3.5. Performance of the Scale Generated
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | CA (n = 52) | UC (n = 80) | p-Value |
---|---|---|---|
Men % (n) Women % (n) | 61.54% (32) 38.46% (20) | 41.25% (33) 58.75% (47) | 0.0227 (*) |
Age (years) | 31.67 ± 17.48 | 34.85 ± 16.61 | 0.1276 |
Self-medication with antibiotics | 25.00% (13) | 14.44% (13) | 0.1171 |
Self-medication with steroidal anti-inflammatory drugs | 61.54% (32) | 55.00% (44) | 0.4577 |
Comorbidities | |||
Diabetes % (n) | 5.77% (3) | 5% (4) | 0.8472 |
Obesity % (n) | 19.23% (10) | 12.50% (10) | 1.111 |
Hypertension % (n) | 5.77% (3) | 2.50% (2) | 0.9242 |
Autoimmune disease % (n) | 0 | 0 | - |
Signs and symptoms | |||
Anorexia | 76.92% (40) | 67.50% (54) | 0.2427 |
Migration of pain | 80.77% (42) | 77.50% (62) | 0.6535 |
Fever greater than 38 °C | 61.54% (32) | 41.25% (33) | 0.0227 (*) |
Nausea/Vomiting | 84.62% (44) | 81.25% (65) | 0.6184 |
Right lower quadrant pain | 98.08% (51) | 100% (80) | 0.2131 |
Right iliac fossa rebound (Blumberg’s sign) | 96.15% (50) | 86.25% (69) | 0.0621 |
Laboratory values | |||
Leukocytes (103/µL) | 16.00 ± 6.119 | 13.88 ± 5.466 | 0.0393 (*) |
Neutrophils (103/µL) | 13.55 ± 6.183 | 11 ± 5.466 | 0.0142 (*) |
Lymphocytes (103/µL) | 1.432 ± 1.244 | 1.693 ± 0.7639 | 0.1377 |
Monocytes (103/µL) | 0.9737 ± 0.5049 | 0.9031 ± 0.4235 | 0.3880 |
Platelets (103/µL) | 273.6 ± 85.07 | 262 ± 69.66 | 0.3943 |
MPV | 10.08 ± 1.058 | 10.15 ± 1.001 | 0.6997 |
aPTT(s) | 29.14 ± 3.356 | 28.95 ± 3.451 | 0.9325 |
PT(s) | 15.99 ± 2.390 | 14.67 ± 1.551 | 0.0002 (***) |
INR | 1.233 ± 0.1978 | 1.122 ± 0.1321 | 0.0001 (****) |
Fibrinogen (mg/dL) | 577.1 ± 165.7 | 438.3 ± 158.4 | <0.0001 (****) |
C-reactive protein (mg/dL) | 11.69 ± 8.816 | 6.872 ± 14.32 | 0.0318 (*) |
Total protein (g/dL) † | 7.410 ± 2.677 | 7.214 ± 1.326 | 0.6836 |
Albumin (g/dL) † | 4.090 ± 0.6973 | 4.228 ± 0.5568 | 0.4215 |
Globulin (g/dL) † | 3.275 ± 0.4153 | 3.192 ± 0.3434 | 0.4233 |
Total Bilirubin (g/dL) † | 1.185 ± 0.5724 | 0.9800 ± 0.6067 | 0.2242 |
Direct bilirubin (g/dL) † | 0.01500 ± 0.06708 | 0.000 ± 0.000 | 0.3571 |
Indirect bilirubin (g/dL) † | 1.170 ± 0.5507 | 0.9778 ± 0.5981 | 0.2414 |
Ultrasound findings | |||
Appendicolith | 3.85% (2) | 1.25% (1) | 0.3281 |
Periappendicular Plastontium | 17.31% (9) | 11.25% (9) | 0.3217 |
Abscess | 9.62% (5) | 1.25% (1) | 0.0242 (*) |
Free fluid in periappendicular cavity | 13.46% (7) | 2.50% (2) | 0.0146 (*) |
Scales and ratios | |||
Alvarado scale points | 7.904 ± 1.376 | 7.375 ± 1.594 | 0.0513 |
RIPASA scale point | 7.394 ± 1.439 | 6.669 ± 1.522 | 0.0043 (**) |
NLR | 13.26 ± 10.56 | 8.800 ± 7.338 | 0.0013 (**) |
PLR | 255.92 ± 174.4 | 188.3 ± 97.95 | 0.0032 (**) |
MLR | 0.9095 ± 0.7878 | 0.6668 ± 0.5074 | 0.0158 (*) |
0.9095 ± 0.7878 | 0.6668 ± 0.5074 | 0.0158 (*) |
Variable | Odds Ratio | p Value |
---|---|---|
Biological sex (male) | 0.904 | 0.342 |
Fever greater than 38 °C | 0.571 | 0.450 |
Free fluid | 4.612 | 0.032 (*) |
Abscess | 3.651 | 0.056 |
Neutrophils count | 0.599 | 0.439 |
Fibrinogen | 8.277 | 0.004 (**) |
INR | 4.651 | 0.031 (*) |
C-reactive protein | 7.533 | 0.006 (**) |
NLR | 0.339 | 0.560 |
PLR | 1.055 | 0.304 |
MLR | 2.903 | 0.088 |
RIPASA score | 3.644 | 0.056 |
Variables | Clinical Features | Odds Ratio | Significance | Score |
---|---|---|---|---|
Fibrinogen > 481.5 mg/dL | 4.692 | 0.030 (*) | 2 | |
INR > 1.15 | 4.479 | 0.034 (*) | 2 | |
C-reactive protein > 7.15 mg/dL | 4.535 | 0.033 (*) | 2 | |
Free fluid | 3.861 | 0.049 (*) | 2 | |
Total score | 8 |
AUC | C.I. 95% L.L. | C.I. 95% U.L. | Cutoff Point | Sensitivity | Specificity | |
---|---|---|---|---|---|---|
NLR | 0.6647 | 0.5718 | 0.7575 | 9.342 | 61.25 | 59.62 |
MLR | 0.6242 | 0.5259 | 0.7224 | 0.6141 | 61.25 | 57.69 |
PLR | 0.6512 | 0.5562 | 0.7462 | 203.0 | 62.50 | 63.46 |
Alvarado scale | 0.5958 | 0.4982 | 0.6934 | 7.500 | 51.25 | 63.46 |
RIPASA scale | 0.6457 | 0.5498 | 0.7416 | 7.250 | 65 | 63.46 |
scale proposed | 0.8465 | 0.7748 | 0.9182 | 3.0 | 78.75 | 82.69 |
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Hernández-González, L.L.; Serrano-Guzmán, S.J.; Guzmán-Ortiz, J.D.; Pérez-Ceballos, H.E.; Cano-Pérez, J.L.; Cruz-Hernández, V.; Bernardino-Hernández, H.U.; Martínez-Martínez, L.L.; Aguilar-Ruiz, S.R. C-Reactive Protein, International Normalized Ratio, and Fibrinogen in Diagnostic Scale of Complicated Acute Appendicitis. Clin. Pract. 2025, 15, 25. https://doi.org/10.3390/clinpract15020025
Hernández-González LL, Serrano-Guzmán SJ, Guzmán-Ortiz JD, Pérez-Ceballos HE, Cano-Pérez JL, Cruz-Hernández V, Bernardino-Hernández HU, Martínez-Martínez LL, Aguilar-Ruiz SR. C-Reactive Protein, International Normalized Ratio, and Fibrinogen in Diagnostic Scale of Complicated Acute Appendicitis. Clinics and Practice. 2025; 15(2):25. https://doi.org/10.3390/clinpract15020025
Chicago/Turabian StyleHernández-González, Leticia Lorena, Said José Serrano-Guzmán, Jesús David Guzmán-Ortiz, Hermelo Esteban Pérez-Ceballos, José Luis Cano-Pérez, Víctor Cruz-Hernández, Héctor Ulises Bernardino-Hernández, Lucía Lourdes Martínez-Martínez, and Sergio Roberto Aguilar-Ruiz. 2025. "C-Reactive Protein, International Normalized Ratio, and Fibrinogen in Diagnostic Scale of Complicated Acute Appendicitis" Clinics and Practice 15, no. 2: 25. https://doi.org/10.3390/clinpract15020025
APA StyleHernández-González, L. L., Serrano-Guzmán, S. J., Guzmán-Ortiz, J. D., Pérez-Ceballos, H. E., Cano-Pérez, J. L., Cruz-Hernández, V., Bernardino-Hernández, H. U., Martínez-Martínez, L. L., & Aguilar-Ruiz, S. R. (2025). C-Reactive Protein, International Normalized Ratio, and Fibrinogen in Diagnostic Scale of Complicated Acute Appendicitis. Clinics and Practice, 15(2), 25. https://doi.org/10.3390/clinpract15020025