MODELO PREDICTIVO PARA LA DETECCIÓN DE APENDICITIS INFLAMATORIA. ESTUDIO OBSERVACIONAL TRANSVERSAL.
DOI:
https://doi.org/10.61164/hv81sn43Palabras clave:
Apendicitis, Histología, Radiología, Tomografía Computarizada por Rayos XResumen
Introducción: El uso excesivo y la interpretación aislada de pruebas de laboratorio, como el recuento de leucocitos, son fuentes reconocidas de errores diagnósticos e intervenciones innecesarias, impulsadas por factores como la medicina defensiva. La evaluación de la apendicitis aguda ejemplifica este desafío. Objetivo: Este estudio buscó evaluar la utilidad aislada del recuento de leucocitos para diferenciar apendicopatías inflamatorias de las no inflamatorias, comparándola con un enfoque combinado que incluye el puntaje de Alvarado y la tomografía computarizada (TC). Metodología: Se realizó un estudio observacional transversal con 140 pacientes sometidos a apendicectomía (125 inflamatorias, 15 no inflamatorias). El rendimiento diagnóstico del recuento de leucocitos, el puntaje de Alvarado y el grado de borrosidad de la grasa periapendicular en la TC se evaluó individualmente y en conjunto mediante curvas ROC y análisis de regresión logística multivariada, teniendo la histopatología como estándar de oro. Resultados: El recuento aislado de leucocitos no difirió significativamente entre los grupos (p=0,527) y su capacidad predictiva no fue superior al azar (AUC=0,525). El puntaje de Alvarado también mostró una baja precisión (AUC=0,397). En contraste, el grado de borrosidad en la TC demostró un excelente rendimiento (AUC=0,934). En el análisis multivariado, solo la borrosidad fue un predictor independiente significativo (p<0,001), y el modelo combinado alcanzó la mayor precisión (AUC=0,957). Conclusión: El recuento aislado de leucocitos es insuficiente para diferenciar las apendicopatías inflamatorias. La precisión diagnóstica óptima se logra con un modelo integrado, en el que los hallazgos tomográficos, particularmente la borrosidad de la grasa periapendicular, son el componente más robusto.
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AFZAL, B. et al. Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables. World Journal of Emergency Surgery, v. 18, n. 1, p. 10, 2023. Disponível em: https://doi.org/10.1186/s13017-023-00478-8. DOI: https://doi.org/10.1186/s13017-023-00478-8
ALELYANI, M. et al. Evaluation of Ultrasound Accuracy in Acute Appendicitis Diagnosis. Applied Sciences, v. 11, n. 6, p. 2682, 2021. Disponível em: https://doi.org/10.3390/app11062682. DOI: https://doi.org/10.3390/app11062682
ALSHWAREB, A. et al. Clinical chemistry laboratory test overuse in a cardiology clinic: a single-center study. Journal of Medicine and Life, v. 16, n. 4, p. 540–545, 2023. Disponível em: https://doi.org/10.25122/jml-2022-0338. DOI: https://doi.org/10.25122/jml-2022-0338
ALVARADO, A. A practical score for the early diagnosis of acute appendicitis. Annals of Emergency Medicine, v. 15, n. 5, p. 557–564, 1986. DOI: https://doi.org/10.1016/S0196-0644(86)80993-3
ARREDONDO MONTERO, J. et al. The BIDIAP index: a clinical, analytical and ultrasonographic score for the diagnosis of acute appendicitis in children. Pediatric Surgery International, v. 39, n. 1, p. 175, 2023. Disponível em: https://doi.org/10.1007/s00383-023-05463-5. DOI: https://doi.org/10.1007/s00383-023-05463-5
ARREDONDO MONTERO, J. et al. Diagnostic Performance of Serum Leucine-Rich Alpha-2-Glycoprotein 1 in Pediatric Acute Appendicitis: A Prospective Validation Study. Biomedicines, v. 12, n. 8, p. 1821, 2024. Disponível em: https://doi.org/10.3390/biomedicines12081821. DOI: https://doi.org/10.3390/biomedicines12081821
ARRUZZA, E. et al. Diagnostic accuracy of computed tomography and ultrasound for the diagnosis of acute appendicitis: A systematic review and meta-analysis. Radiography, v. 28, n. 4, p. 1127–1141, 2022. Disponível em: https://doi.org/10.1016/j.radi.2022.08.012. DOI: https://doi.org/10.1016/j.radi.2022.08.012
BAI, S. et al. The Value of the Alvarado Score for the Diagnosis of Acute Appendicitis in Children: A Systematic Review and Meta-Analysis. Journal of Pediatric Surgery, v. 58, n. 10, p. 1886–1892, 2023. Disponível em: https://doi.org/10.1016/j.jpedsurg.2023.02.060. DOI: https://doi.org/10.1016/j.jpedsurg.2023.02.060
BAIN, B. J. Diagnosis from the Blood Smear. New England Journal of Medicine, v. 353, n. 5, p. 498–507, 2005. Disponível em: https://doi.org/10.1056/NEJMra043442. DOI: https://doi.org/10.1056/NEJMra043442
BASHER, M. O. S.; AHMED, A. A.; HAMZA, A. A. Mean platelet volume and total white blood cells as diagnostic biomarkers for acute appendicitis at Omdurman military hospital: a cross-sectional study − 2021. BMC Gastroenterology, v. 23, n. 1, p. 444, 2023. Disponível em: https://doi.org/10.1186/s12876-023-03091-w. DOI: https://doi.org/10.1186/s12876-023-03091-w
D'SOUZA, N. et al. Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis. Cochrane Database of Systematic Reviews, n. 12, CD012028, 2021. Disponível em: https://doi.org/10.1002/14651858.CD012028.pub2. DOI: https://doi.org/10.1002/14651858.CD012028.pub2
DANIELS, L.; MARNEFFE, W. Does patient behaviour drive physicians to practice defensive medicine? Evidence from a video experiment. Health Economics Review, v. 13, p. 45, 2023. Disponível em: https://doi.org/10.1186/s13561-023-00458-3. DOI: https://doi.org/10.1186/s13561-023-00458-3
DEVIS, L. et al. Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review. Annals of Intensive Care, v. 14, p. 9, 2024. Disponível em: https://doi.org/10.1186/s13613-024-01244-y. DOI: https://doi.org/10.1186/s13613-024-01244-y
DONLON, N. E. et al. Negative appendicectomy rates as a quality measure in a regional surgical unit: a retrospective review. Irish Journal of Medical Science, v. 190, p. 755–761, 2021. Disponível em: https://doi.org/10.1007/s11845-020-02360-1. DOI: https://doi.org/10.1007/s11845-020-02360-x
FAWKNER-CORBETT, D. et al. Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis. BMJ Open, v. 12, n. 11, e056854, 2022. Disponível em: https://doi.org/10.1136/bmjopen-2021-056854. DOI: https://doi.org/10.1136/bmjopen-2021-056854
FU, J. et al. Abdominal Ultrasound and Its Diagnostic Accuracy in Diagnosing Acute Appendicitis: A Meta-Analysis. Frontiers in Surgery, v. 8, p. 707160, 2021. Disponível em: https://doi.org/10.3389/fsurg.2021.707160. DOI: https://doi.org/10.3389/fsurg.2021.707160
HAIJANEN, J. et al. Diagnostic accuracy using low-dose versus standard radiation dose CT in suspected acute appendicitis: prospective cohort study. British Journal of Surgery, v. 108, n. 12, p. 1483–1490, 2021. Disponível em: https://doi.org/10.1093/bjs/znab383. DOI: https://doi.org/10.1093/bjs/znab383
HENRIKSEN, S. R. et al. Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis. Langenbeck's Archives of Surgery, v. 408, n. 1, p. 205, 2023. Disponível em: https://doi.org/10.1007/s00423-023-02949-z. DOI: https://doi.org/10.1007/s00423-023-02935-z
HUCKINS, D. S.; COPELAND, K. Diagnostic accuracy of combined WBC, ANC and CRP in adult emergency department patients suspected of acute appendicitis. The American Journal of Emergency Medicine, v. 44, p. 401–406, 2021. Disponível em: https://doi.org/10.1016/j.ajem.2020.04.086. DOI: https://doi.org/10.1016/j.ajem.2020.04.086
ISLAM, G. M. N. et al. Abbreviated MRI in patients with suspected acute appendicitis in emergency: a prospective study. Abdominal Radiology, v. 46, p. 5114–5124, 2021. Disponível em: https://doi.org/10.1007/s00261-021-03223-2. DOI: https://doi.org/10.1007/s00261-021-03222-5
ISMAIL, A. A. When laboratory tests can mislead even when they appear plausible. Clinical Medicine (London), v. 17, n. 4, p. 329–332, 2017. Disponível em: https://doi.org/10.7861/clinmedicine.17-4-329. DOI: https://doi.org/10.7861/clinmedicine.17-4-329
KATZ, A. R. et al. False-Positive Gonorrhea Test Results with a Nucleic Acid Amplification Test: The Impact of Low Prevalence on Positive Predictive Value. Clinical Infectious Diseases, v. 38, n. 6, p. 814–819, 2004. Disponível em: https://doi.org/10.1086/381895. DOI: https://doi.org/10.1086/381895
KIM, M. H. et al. Clinical approach to sexually transmitted infections and pelvic inflammatory disease in women with acute pyelonephritis. The Korean Journal of Internal Medicine, v. 40, n. 3, p. 482–490, 2025. Disponível em: https://doi.org/10.3904/kjim.2024.213. DOI: https://doi.org/10.3904/kjim.2024.213
KRISEM, M. et al. Appendiceal wall thickness and Alvarado score are predictive of acute appendicitis in the patients with equivocal computed tomography findings. Scientific Reports, v. 13, n. 1, p. 998, 2023. Disponível em: https://doi.org/10.1038/s41598-023-27984-8. DOI: https://doi.org/10.1038/s41598-023-27984-8
LAM, J. H. et al. Why clinicians overtest: development of a thematic framework. BMC Health Services Research, v. 20, p. 1011, 2020. Disponível em: https://doi.org/10.1186/s12913-020-05844-9. DOI: https://doi.org/10.1186/s12913-020-05844-9
LEHMANN, B. et al. Diagnostic accuracy of a pragmatic, ultrasound-based approach to adult patients with suspected acute appendicitis in the ED. Emergency Medicine Journal, v. 38, n. 3, p. 179-183, 2021. Disponível em: https://doi.org/10.1136/emermed-2019-208643. DOI: https://doi.org/10.1136/emermed-2019-208643
LIN, H. A. et al. Periappendiceal fat-stranding models for discriminating between complicated and uncomplicated acute appendicitis. World Journal of Emergency Surgery, v. 16, n. 1, p. 52, 2021. Disponível em: https://doi.org/10.1186/s13017-021-00398-5. DOI: https://doi.org/10.1186/s13017-021-00398-5
LUBIN, I. M. et al. Bringing the clinical laboratory into the strategy to advance diagnostic excellence. Diagnosis (Berlin), v. 8, n. 3, p. 281–294, 2021. Disponível em: https://doi.org/10.1515/dx-2020-0119. DOI: https://doi.org/10.1515/dx-2020-0119
LUKSAITE-LUKSTE, R. et al. Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT. Journal of Clinical Medicine, v. 10, n. 11, p. 2456, 2021. Disponível em: https://doi.org/10.3390/jcm10112456. DOI: https://doi.org/10.3390/jcm10112456
MALKOMES, P. et al. DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis. Langenbeck's Archives of Surgery, v. 406, n. 1, p. 141–152, 2020. Disponível em: https://doi.org/10.1007/s00423-020-02022-7. DOI: https://doi.org/10.1007/s00423-020-02022-7
MARKWART, R. et al. Utilisation and trends of laboratory testing and point-of-care testing in primary care in Germany: an analysis of claims data. BMJ Open, v. 14, n. 12, e093780, 2024. Disponível em: https://doi.org/10.1136/bmjopen-2024-093780. DOI: https://doi.org/10.1136/bmjopen-2024-093780
MEKRUGSAKIT, N.; TULLAVARDHANA, T. The Value of Complete Blood Count Parameters in Predicting Complicated Acute Appendicitis; a Prognostic Accuracy Study. Archives of Academic Emergency Medicine, v. 11, n. 1, e42, 2023. Disponível em: https://doi.org/10.22037/aaem.v11i1.2020.
MOTAVASELIAN, M. et al. Diagnostic Performance of Magnetic Resonance Imaging for Detection of Acute Appendicitis in Pregnant Women; a Systematic Review and Meta-Analysis. Archives of Academic Emergency Medicine, v. 10, n. 1, e81, 2022. Disponível em: https://doi.org/10.22037/aaem.v10i1.1727.
NOVOA, P. C. R. What changes in Research Ethics in Brazil: Resolution no. 466/12 of the National Health Council. Einstein (São Paulo), v. 12, n. 1, p. vii–ix, 2014. Disponível em: https://doi.org/10.1590/S1679-45082014ED3077. DOI: https://doi.org/10.1590/S1679-45082014ED3077
NYAMURYEKUNG’E, M. K. et al. Diagnostic accuracy of computed tomography in adults with suspected acute appendicitis at the emergency department in a private tertiary hospital in Tanzania. PLoS ONE, v. 17, n. 10, e0276720, 2022. Disponível em: https://doi.org/10.1371/journal.pone.0276720. DOI: https://doi.org/10.1371/journal.pone.0276720
OLVER, P.; BOHN, M. K.; ADELI, K. Central role of laboratory medicine in public health and patient care. Clinical Chemistry and Laboratory Medicine, v. 61, n. 4, p. 666–673, 2022. Disponível em: https://doi.org/10.1515/cclm-2022-1075. DOI: https://doi.org/10.1515/cclm-2022-1075
PAN, Z. B. et al. Analysis of type I hypersensitivity-induced inflammatory response in children of different age groups with acute appendicitis. Molecular Immunology, v. 158, p. 103–106, 2023. Disponível em: https://doi.org/10.1016/j.molimm.2023.05.002. DOI: https://doi.org/10.1016/j.molimm.2023.05.002
PARK, K. B. et al. Relationship Between Appendectomy Incidence and Computed Tomography Scans Based on Korean Nationwide Data, 2003–2017. Journal of Korean Medical Science, v. 37, n. 4, e27, 2022. Disponível em: https://doi.org/10.3346/jkms.2022.37.e27. DOI: https://doi.org/10.3346/jkms.2022.37.e27
SHAIK, T. et al. Lab testing overload: a comprehensive analysis of overutilization in hospital-based settings. Proceedings (Baylor University. Medical Center), v. 37, n. 2, p. 312–316, 2024. Disponível em: https://doi.org/10.1080/08998280.2023.2288788. DOI: https://doi.org/10.1080/08998280.2023.2288788
SHENOY, A.; SHENOY, G. N.; SHENOY, G. G. Patient safety assurance in the age of defensive medicine: a review. Patient Safety in Surgery, v. 16, p. 10, 2022. Disponível em: https://doi.org/10.1186/s13037-022-00319-8. DOI: https://doi.org/10.1186/s13037-022-00319-8
SIPPOLA, S. et al. The Accuracy of Low-dose Computed Tomography Protocol in Patients With Suspected Acute Appendicitis: The OPTICAP Study. Annals of Surgery, v. 271, n. 2, p. 332–338, 2020. Disponível em: https://doi.org/10.1097/SLA.0000000000002976. DOI: https://doi.org/10.1097/SLA.0000000000002976
SONG, X. et al. Relative CT number of periappendiceal fat stranding may be an applicable index for estimating the severity of acute appendicitis. The British Journal of Radiology, v. 94, n. 1120, 20200437, 2021. Disponível em: https://doi.org/10.1259/bjr.20200437. DOI: https://doi.org/10.1259/bjr.20200437
TAN, W. J. et al. Randomized control trial comparing an Alvarado Score-based management algorithm and current best practice in the evaluation of suspected appendicitis. World Journal of Emergency Surgery, v. 15, n. 1, p. 30, 2020. Disponível em: https://doi.org/10.1186/s13017-020-00309-0. DOI: https://doi.org/10.1186/s13017-020-00309-0
THE JAMOVI PROJECT. jamovi. Version 1.6. [S.l.]: The jamovi project, 2022. Disponível em: https://www.jamovi.org.
TURKES, G. F.; UNSAL, A.; BULUS, H. Predictive value of immature granulocyte in the diagnosis of acute complicated appendicitis. PLoS ONE, v. 17, n. 12, e0279316, 2022. Disponível em: https://doi.org/10.1371/journal.pone.0279316. DOI: https://doi.org/10.1371/journal.pone.0279316
VON ELM, E. et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet, v. 370, n. 9596, p. 1453–1457, 2007. Disponível em: https://doi.org/10.1016/S0140-6736(07)61602-X. DOI: https://doi.org/10.1016/S0140-6736(07)61602-X
VYBERG, M. et al. Immunohistochemical expression of HER2 in breast cancer: socioeconomic impact of inaccurate tests. BMC Health Services Research, v. 15, p. 352, 2015. Disponível em: https://doi.org/10.1186/s12913-015-1018-6. DOI: https://doi.org/10.1186/s12913-015-1018-6
WILLIAMS, J. et al. Pediatric Appendicitis Transfers From Adult Centers: Can Alvarado Scores Help Determine Which Patients Need a CT? The American Surgeon, v. 89, n. 7, p. 3329-3331, 2023. Disponível em: https://doi.org/10.1177/00031348231157838. DOI: https://doi.org/10.1177/00031348231157838
YAZLA, M. et al. Predictive efficacy of immature granulocytes in acute complicated appendicitis. Revista da Associação Médica Brasileira, v. 70, n. 12, e20241178, 2024. Disponível em: https://doi.org/10.1590/1806-9282.20241178. DOI: https://doi.org/10.1590/1806-9282.20241178
ZAYED, A. M.; DELVAUX, N. Analyzing laboratory test utilization trends in belgian primary care: a decade of insights with international perspectives. BMC Primary Care, v. 25, p. 270, 2024. Disponível em: https://doi.org/10.1186/s12875-024-02536-9. DOI: https://doi.org/10.1186/s12875-024-02536-9
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