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Abstract(s)
Introdução: A apendicite aguda (AA) é a causa mais comum de intervenção cirúrgica urgente e é um dos principais diagnósticos diferenciais de abdómen agudo em qualquer idade. O diagnóstico de AA é essencialmente clínico, constituído pelos sinais clássicos e sintomas típicos. Não raramente, o diagnóstico de AA torna-se um desafio com apresentações atípicas, principalmente nos extremos etários. Um diagnóstico precoce é fundamental para um correto tratamento da AA. Não existe nenhum um marcador que discrimine a AA de outras causas de dor abdominal e os marcadores serológicos mais utilizados são a leucocitose, a neutrofilia, a elevação da proteína C-reativa (PCR) e o hematócrito. Quando se analisa a literatura em relação à avaliação do prognóstico da AA verifica-se que são poucos os estudos que o definem e o avaliam.
Objetivo: O principal objetivo é a avaliação da relação neutrófilos/linfócitos (N/L) e plaquetas/linfócitos (P/L) como ferramenta prognóstica da AA.
Métodos: Estudo retrospetivo, observacional de doentes submetidos a apendicectomia de urgência na Unidade Local de Saúde de Castelo Branco no ano de 2015, baseado na análise dos processos clínicos. A análise dos dados estatísticos foi elaborada no software SPSS-21.0®.
Resultados: Quarenta (42.1%) doentes tiveram AA não complicada e 55 (57.9%) apresentaram AA complicada. A relação N/L apresentou melhor acuidade (0.77 (0.68-0.87)) para a gravidade da AA, seguida pela PCR (0.71(0.59-0.81)), relação P/L (0.67(0.56-0.77)) e EA (0.66 (0.56-0.77)). Para um cut-off de 6.6 a relação N/L apresentou uma sensibilidade de 75% e especificidade de 69.1%, enquanto a relação P/L, para um cut-off de 150 apresentou uma sensibilidade e especificidade de 80% e 54.5%, respetivamente.
Conclusão: A relação N/L pode ser uma importante ferramenta de prognóstico da AA e a relação P/L também pode ser usada como marcador de prognóstico, embora com menor acuidade do que a relação N/L.
Introduction: The Acute Appendicitis (AA) is the most common cause of surgical intervention in the Emergency Room setting. It is one of the main differential diagnoses of abdominal pain at any age. The diagnosis of AA is essentially clinical, consisting of classic signs and typical symptoms. Not rarely, the diagnosis of AA is a challenge with atypical presentations, mainly in the very young and the ederly. An early diagnosis is critical for a correct treatment of the AA. There are no specific laboratory findings that differenciate AA from other causes of abdominal pain, being the most commonly used serologic markers the white blood cell count, C-reactive protein (CRP) and platelet count. There are very few studies on the evaluation of the prognosis of AA. Objective: The main goal is to evaluate the neutrophil/lymphocyte (N/L) ratio and platelet/lymphocyte (P/L) ratio as a prognostic tool for AA. Methods: Retrospective and observational study of patients undergoing appendectomy at the Unidade Local de Saúde de Castelo Branco during 2015. Data was collected by means of analysis of the clinical processes. Statistical data analysis was performed using SPSS Statistics-21.0® software. Results: A total of 95 patients were included, 40 (42.1%) patients had uncomplicated AA and 55 (57.9%) had complicated AA. The N/L ratio presented a better accuracy (0.77 (0.68-0.87)) for the severity of AA, followed by CRP (0.71 (0.59-0.81)), P/L ratio (0.67 (0.56-0.77)) and the Alvarado Score (0.56-0.77)). The established cut-off of 6.6 the N/L ratio had a sensitivity of 75% and specificity of 69.1%, while the P/L ratio using a cut-off of 150 showed 80% and 54.5% respectively. Conclusion: We believe the N/L ratio to be an useful prognostic tool for the severy of AA and, to a lesser extent, so can the P/L ratio.
Introduction: The Acute Appendicitis (AA) is the most common cause of surgical intervention in the Emergency Room setting. It is one of the main differential diagnoses of abdominal pain at any age. The diagnosis of AA is essentially clinical, consisting of classic signs and typical symptoms. Not rarely, the diagnosis of AA is a challenge with atypical presentations, mainly in the very young and the ederly. An early diagnosis is critical for a correct treatment of the AA. There are no specific laboratory findings that differenciate AA from other causes of abdominal pain, being the most commonly used serologic markers the white blood cell count, C-reactive protein (CRP) and platelet count. There are very few studies on the evaluation of the prognosis of AA. Objective: The main goal is to evaluate the neutrophil/lymphocyte (N/L) ratio and platelet/lymphocyte (P/L) ratio as a prognostic tool for AA. Methods: Retrospective and observational study of patients undergoing appendectomy at the Unidade Local de Saúde de Castelo Branco during 2015. Data was collected by means of analysis of the clinical processes. Statistical data analysis was performed using SPSS Statistics-21.0® software. Results: A total of 95 patients were included, 40 (42.1%) patients had uncomplicated AA and 55 (57.9%) had complicated AA. The N/L ratio presented a better accuracy (0.77 (0.68-0.87)) for the severity of AA, followed by CRP (0.71 (0.59-0.81)), P/L ratio (0.67 (0.56-0.77)) and the Alvarado Score (0.56-0.77)). The established cut-off of 6.6 the N/L ratio had a sensitivity of 75% and specificity of 69.1%, while the P/L ratio using a cut-off of 150 showed 80% and 54.5% respectively. Conclusion: We believe the N/L ratio to be an useful prognostic tool for the severy of AA and, to a lesser extent, so can the P/L ratio.
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Keywords
Apendicite Aguda Gravidade Prognóstico Relação Neutrófilos/Linfócitos Relação Plaquetas/Linfócitos