Complicated appendicitis: value of inflammatory markers based on EAES 2015 guidelines

Area of Science:

• Gastroenterology
• Surgical Pathology
• Clinical Diagnostics

Background:

• Phlegmonous appendicitis (PHL) clinical presentation raises questions about its classification as complicated acute appendicitis (CAA).
• The European Association for Endoscopic Surgery (EAES) 2015 guidelines classify PHL as CAA, typically requiring surgical intervention.
• This study investigates the clinical relevance of classifying PHL as CAA, focusing on inflammatory markers, surgical outcomes, and hospital stay.

Purpose of the Study:

• To evaluate the clinical significance of classifying phlegmonous appendicitis (PHL) as complicated acute appendicitis (CAA).
• To analyze the role of inflammatory markers, specifically C-reactive protein (CRP) and leucocyte counts, in assessing disease severity.
• To determine the impact of PHL classification on postoperative complications and hospital length of stay.

Main Methods:

• Retrospective single-center study of 559 adult appendectomy patients (2016-2020).
• Intraoperative classification adhered to EAES 2015 guidelines.
• Analysis of preoperative CRP and leucocyte counts in relation to disease severity, complications, and hospital stay.

Main Results:

• Phlegmonous appendicitis (PHL) constituted 30.8% of complicated appendicitis (CAA) cases.
• C-reactive protein (CRP) levels were significantly higher in CAA than uncomplicated appendicitis (UAA) and correlated with disease severity (Median 48.4 vs. 8.8 mg/L).
• PHL demonstrated a 2.3-fold increased risk of postoperative complications and a 21% longer hospital stay, with elevated CRP predicting these outcomes.

Conclusions:

• Phlegmonous appendicitis (PHL) exhibits a distinct clinical profile justifying its classification as complicated appendicitis (CAA).
• Elevated C-reactive protein (CRP) is a key indicator of PHL severity and associated risks.
• Findings support the continued classification of PHL as CAA under EAES 2015 guidelines.