Analysis On Risk Factors Of Adult Actue Complicated Appendicitis

Objective : By a retrospective analysis of acute appendicitis preoperative clinical manifestations and laboratory examinations,to obtain the high risk factors of complicated appendicitis,and to establish a multi-factors logistic regression model.To identify complicated appendicitis in time,and choose the proper treatment method.Methods: the present study is retrospective made on 312 patients treatment for acute appendicitis with appendectomy in the Affiliated Hospital of Qingdao University from May 2011 to August 2016.the diagnostic criteria of acute complicated appendicitis: had postoperative pathological diagnosis of acute gangrenous appendicitis,acute perforated appendicitis,acute suppurative appendicitis.Exclusion criteria:(1)the appendicitis diagnosis is not clear;(2)the pregnant women(3)age less than 14 years old.The patients were divided into acute uncomplicated appendicitis group and acute complicated appendicitis group according to the postoperative pathology.The clinical data of two groups,including the elderly patients(≥60),BMI,gender,preoperative onset time,preoperative vomiting,abdominal rebound pain,preoperative high fever(≥39 ℃),a history of appendicitis,preoperative application of antibiotics,albumin,white blood cells(WBC),neutrophil count,neutrophil percentage,lymphocyte count,monocyte count,erythrocyte count,hematocrit,hemoglobin,platelet count,C-reactive protein(CRP),serum albumin,D-dimer and other indicators,and a database document was established.Statistical analysis was performed,which t test was used for quantitative data and chi-square test for counting data,furthermore.Then,multiple logistic regression was analysis was used in selected variables and a predictive model was developed.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of predicting the risk factors of the complexity of acute appendicitis were evaluated.I have statistics 100 patients treatment for acute appendicitis with appendectomy in the Affiliated Hospital of Qingdao University from September 2016 to September 2017.Select the statistical significance indicators about high risk factors of acute complicated appendicitis.The sensitivity,specificity and accuracy,positive predictive value,and negative predictive value of acute complex appendicitis in this period were predicted by logistic regression model.Results: There were 10 statistically significant risk factors related high risk factors of the complexity of acute appendicitis: preoperative onset time,white blood cell(WBC),neutrophil,the percentage of neutrophils,C-reactive protein(CRP),serum albumin,vomiting,high fever(≥ 39℃)and the elderly patients(over 60 years),a history of appendicitis.6 of 10 risk factors were independent risk factors associated with high risk factors of the complexity of acute appendicitis,which were the elderly patients(≥60)X1(OR=5.094),high fever(≥39 ℃)X2(OR=4.446),neutrophil count X6(OR=1.269),the percentage of neutrophil X4(OR=1.077),C-reactive protein X45(OR=1.027),serum albumin X1(OR=0.763),.The logistic regression equation was P=l/(1+e(0.557+1.628X1+1.496X2-2.7X3+0.74X4+0.27X5+0.238X6)),which sensitivity,specificity,accuracy positive predictive value and negative predictive value of predicting model were 76.8%,90%,85.3%,81.1%,87.4%.Using the logistic regression model to predict 100 patients treatment for acute appendicitis with appendectomy in the Affiliated Hospital of Qingdao University from September 2016 to September 2017,which sensitivity,specificity,accuracy positive predictive value and negative predictive value of predicting model were 76.2%,81.1%,78%,92.7%,66.7%Conclusion: neutrophil count,C-reactive protein,neutrophil percentage,high fever(≥39℃),preoperative onset time,hypoalbuminemia,the elderly patients(≥60))are associated with high risk factors of the complexity of acute appendicitis.The logistic regressive model based on these risk factors is reliable in predicting high risk factors of the complexity of acute appendicitis.In time to distinguish the type of appendicitis and select correct and reasonable treatment methods,can shorten the time of hospitalization and can reduce the cost of hospitalization.