Inflammatory Response in Appendicitis
Condition: Appendicitis
MeSH terms: Appendicitis
Study type: Observational

Summary: 
      Although the presence of SIRS has been described in patients with appendicitis, its
      progressive response related and together with progression of symptomatology from the onset
      of symptoms to diagnostic has not been characterized. Continuation of the systemic
      inflammation in patients with injury and infectious processes may result in multiple organ
      dysfunction and ultimately failure. As with any acute inflammatory condition, the patients'
      systemic inflammatory response to appendicitis will progress and become more intense with the
      passing of time. The purpose of this study is to characterize the systemic inflammatory
      response to appendicitis from the beginning of symptoms to diagnostic in patients with
      appendicitis submitted to emergency surgery.
    

Detailed description: 
      -  A prospective non-interventional, observational, descriptive study was conducted.

        -  At our institution a median of 250 adult patients are submitted to emergency
           appendectomy every year. From this universe, a sample of 152 patients with a power of
           80%, an error of 5% and 95% Confidence Intervals was required to perform this study.

        -  We included 268 patients in the database, of them 85 cases that did not comply with the
           inclusion criteria were excluded from the analysis. A total of 183 patients (100%)
           selected according to the following criteria were studied: Patients with appendicitis
           confirmed by histology operated on our institutional Emergency Unit with an age range
           from 15 to 80 years.

        -  Any patient with immunosuppressive or immunodeppressive known pathological conditions
           was excluded, as well as any patient with a pathological report describing a normal
           appendix.

        -  Patients were divided into four groups according to the interval of time calculated from
           the onset of symptoms to diagnostic: Group I from 0 to 24 h, Group II from 25 to 48 h,
           Group III from 49 to 72 h and Group IV more than 73 h.

        -  At admission demographic, clinical data, and the interval of time from the onset of
           symptoms to diagnostic was recorded, together with the White Blood Cell (WBC) count,
           C-reactive protein (CRP) values, and SIRS score.

        -  The primary outcome measure was to determine the expected systemic inflammatory response
           to acute appendicitis according to established groups of time intervals from the onset
           of symptoms to diagnostic using the SIRS for that purpose.

        -  The secondary outcome measure was the analysis of the CRP to measure the systemic
           inflammatory response, as another parameter which is habitually included within the
           diagnostic study of patients with suspected appendicitis.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients with appendicitis operated on and confirmed with biopsy
      
Keywords: Appendicitis; SIRS; C-reactive protein