Abstract：
BACKGROUND: The aim of this study was to find statistically valid criteria to preoperatively divide acute appendicitis into simple and complicated to enable surgeons to administer the most appropriate antibiotic prophylaxis/therapy before surgery.
METHODS: We retrospectively reviewed a cohort of patients who underwent appendectomy from January 2022 to December 2023. Patients included were 0-14 years of age. Exclusion criteria included patients who underwent interval appendectomy or concurrent procedures at the same time of appendectomy. We divided patients into two groups: simple (group S) and complicated (group C) appendicitis according to intraoperative finding. Generalized linear model (GLM) with logit function was developed to identify the predictive variables of the type of appendicitis (S vs C) in terms of CRP value, neutrophils percentage and WBC count adjusted for age and sex of patients. Finally, principal component analysis (PCA) was carried out to identify the cutoff value of statistically significant variables found in the previous analysis.
RESULTS: One hundred and twenty patients were eligible (N female = 49, N male = 71) for the study. 74 and 46 patients were included in groups S and C, respectively. In a preliminary analysis using univariate and multivariate GLM, only CRP (p value = < 0.001) and neutrophils percentage (p value = 0.02) were predictive variables for the type of appendicitis. The GLM shows a statistical lower value of CRP (adjusted odds ratio [OR] per unit, 0.17 [95% CI, 0.08-0.39]) and neutrophil percentage (adjusted OR per unit, 0.37 [95% CI, 0.16-0.86]) in the S group compared to C adjusted to age and sex. PCA analysis revealed a P-ROC cutoff of 4.2 mg/dl and 80.1 of CRP value (AUC = 84%) and neutrophil percentage (AUC = 70%), respectively.
CONCLUSIONS: We will perform a prospective study giving preoperative prophylactic cefazolin to patients with a CRP value under 4.2 mg/dl and amoxicillin-clavulanate therapy to patient with CRP value over 4.2 mg/dl.
METHODS: We retrospectively reviewed a cohort of patients who underwent appendectomy from January 2022 to December 2023. Patients included were 0-14 years of age. Exclusion criteria included patients who underwent interval appendectomy or concurrent procedures at the same time of appendectomy. We divided patients into two groups: simple (group S) and complicated (group C) appendicitis according to intraoperative finding. Generalized linear model (GLM) with logit function was developed to identify the predictive variables of the type of appendicitis (S vs C) in terms of CRP value, neutrophils percentage and WBC count adjusted for age and sex of patients. Finally, principal component analysis (PCA) was carried out to identify the cutoff value of statistically significant variables found in the previous analysis.
RESULTS: One hundred and twenty patients were eligible (N female = 49, N male = 71) for the study. 74 and 46 patients were included in groups S and C, respectively. In a preliminary analysis using univariate and multivariate GLM, only CRP (p value = < 0.001) and neutrophils percentage (p value = 0.02) were predictive variables for the type of appendicitis. The GLM shows a statistical lower value of CRP (adjusted odds ratio [OR] per unit, 0.17 [95% CI, 0.08-0.39]) and neutrophil percentage (adjusted OR per unit, 0.37 [95% CI, 0.16-0.86]) in the S group compared to C adjusted to age and sex. PCA analysis revealed a P-ROC cutoff of 4.2 mg/dl and 80.1 of CRP value (AUC = 84%) and neutrophil percentage (AUC = 70%), respectively.
CONCLUSIONS: We will perform a prospective study giving preoperative prophylactic cefazolin to patients with a CRP value under 4.2 mg/dl and amoxicillin-clavulanate therapy to patient with CRP value over 4.2 mg/dl.
摘要：
背景：本研究的目的是寻找统计学上有效的标准，将术前急性阑尾炎分为简单和复杂两种，以使外科医生在手术前给予最适当的抗生素预防/治疗。
方法：我们回顾性回顾了2022年1月至2023年12月接受阑尾切除术的患者队列。包括的患者年龄为0-14岁。排除标准包括在阑尾切除术的同时进行间隔阑尾切除术或同时进行手术的患者。根据术中发现将患者分为两组：单纯（S组）和复杂（C组）阑尾炎。建立了具有logit函数的广义线性模型(GLM),以CRP值识别阑尾炎类型(SvsC)的预测变量,中性粒细胞百分比和白细胞计数根据患者的年龄和性别进行了调整。最后,进行主成分分析(PCA),以确定先前分析中发现的具有统计学意义的变量的截止值.
结果：120名患者符合研究条件（N女性=49，N男性=71）。74和46例患者分为S组和C组，分别。在使用单变量和多变量GLM的初步分析中，只有CRP(p值=<0.001)和中性粒细胞百分比(p值=0.02)是阑尾炎类型的预测变量.GLM显示CRP的统计学较低值(单位调整后的比值比[OR]，0.17[95%CI，0.08-0.39])和中性粒细胞百分比(调整后的单位OR，S组0.37[95％CI，0.16-0.86]）与C相比，根据年龄和性别进行了调整。PCA分析显示，P-ROC截止值为4.2mg/dl，CRP值（AUC=84％）和中性粒细胞百分比（AUC=70％）为80.1，分别。
结论：我们将进行一项前瞻性研究，对CRP值低于4.2mg/dl的患者给予术前预防性头孢唑林，对CRP值高于4.2mg/dl的患者给予阿莫西林-克拉维酸治疗。
方法：我们回顾性回顾了2022年1月至2023年12月接受阑尾切除术的患者队列。包括的患者年龄为0-14岁。排除标准包括在阑尾切除术的同时进行间隔阑尾切除术或同时进行手术的患者。根据术中发现将患者分为两组：单纯（S组）和复杂（C组）阑尾炎。建立了具有logit函数的广义线性模型(GLM),以CRP值识别阑尾炎类型(SvsC)的预测变量,中性粒细胞百分比和白细胞计数根据患者的年龄和性别进行了调整。最后,进行主成分分析(PCA),以确定先前分析中发现的具有统计学意义的变量的截止值.
结果：120名患者符合研究条件（N女性=49，N男性=71）。74和46例患者分为S组和C组，分别。在使用单变量和多变量GLM的初步分析中，只有CRP(p值=<0.001)和中性粒细胞百分比(p值=0.02)是阑尾炎类型的预测变量.GLM显示CRP的统计学较低值(单位调整后的比值比[OR]，0.17[95%CI，0.08-0.39])和中性粒细胞百分比(调整后的单位OR，S组0.37[95％CI，0.16-0.86]）与C相比，根据年龄和性别进行了调整。PCA分析显示，P-ROC截止值为4.2mg/dl，CRP值（AUC=84％）和中性粒细胞百分比（AUC=70％）为80.1，分别。
结论：我们将进行一项前瞻性研究，对CRP值低于4.2mg/dl的患者给予术前预防性头孢唑林，对CRP值高于4.2mg/dl的患者给予阿莫西林-克拉维酸治疗。
