Key result
COVID-19 pandemic presentation linked to a ~4-fold higher appendicitis perforation rate and elevated inflammatory scores.
Why the study?
The study was conducted to investigate clinical variations in Systemic Inflammatory Response Index (SIRI), Systemic Inflammation Index (SII), and Alvarado Score during the COVID-19 pandemic.
Do SIRI, SII, and Alvarado scores differ in acute appendicitis patients operated on during versus before the COVID-19 pandemic?
Cohort (n=161)
No
Do SIRI, SII, and Alvarado scores differ in acute appendicitis patients operated on during versus before the COVID-19 pandemic?
Absolute Event Rate: 46.1% vs 11.1%
p-value: p=<0.001
The COVID-19 pandemic was associated with delayed diagnosis of acute appendicitis, leading to more complications and higher inflammatory scores (SIRI, SII, Alvarado).
May signal need for vigilance during care disruptions; leaves open whether SIRI/SII enhance Alvarado-based risk stratification.
BACKGROUND: The aim of the study was to investigate the clinical variations of Systemic Inflammatory Response Index (SIRI), Systemic Inflammation Index (SII), and Alvarado Score during the COVID-19 pandemic period. METHODS: Between March 2019 and March 2021, 161 consecutive patients who had surgery due to acute appendicitis were ret-rospectively recruited from Trakya University in Edirne, Turkey. Group I included patients who had surgery during the COVID-19 pandemic and Group II included patients who had surgery before the COVID-19 pandemic period. A total of 80 patients volunteered for Group I and 81 patients for Group II. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, and lymphocyte/monocyte ratio were calculated. SII was calculated by the formula: platelet (P) × neutrophil (N)/lymphocyte (L). NLR was calculated by dividing the neutrophil count by the number of lymphocytes. SIRI was defined as follows: SIRI = (neutrophil × monocyte/lymphocyte). The Alvarado score was also calculated by using patient history, clinical examination, and laboratory findings. RESULTS: There was a significant difference between the two groups in terms of displacing pain, nausea/vomiting, right lower quad-rant tenderness, rebound, hyperthermia, leukocytosis, and total Alvarado score (p<0.001). There was a significant difference between two groups in comparison of C-reactive protein, SIRI, and SII values (p<0.001). Group I patients had higher values of these parameters than Group II. CONCLUSION: Based on the results obtained from this study, we conclude that COVID-19 pandemic has caused an increase in patients with acute appendicitis admitted to the hospital. This late diagnosis of acute appendicitis caused more complications during COVID-19 pandemic. Alvarado score, SIRI, and SII can be used as a marker to indicate whether complications of acute appendicitis occurred pre- or post-operatively. Therefore, Alvarado score, SIRI, and SII are directly proportional to the complication of acute appendicitis.
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İbrahim Ethem Cakcak (2022) conducted a cohort in Acute appendicitis (n=161). COVID-19 pandemic period vs. Pre-COVID-19 pandemic period was evaluated on Perforation rate (p=<0.001). Presentation during the COVID-19 pandemic was associated with a significantly higher perforation rate (46.1% vs 11.1%) and elevated SIRI, SII, and Alvarado scores compared to the pre-pandemic period.
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