Akademik Veri Yönetim Sistemi
Annals of Medicine and Surgery, cilt.75, sa.3, ss.103391, 2022 (ESCI)
Comment to: “Inflammatory parameters as predictive factors for complicated appendicitis: A retrospective cohort study’’
Dear Editor,
We have read the valuable article titled “Inflammatory parameters as predictive factors for
complicated appendicitis: A retrospective cohort study’’ by Ribeiro et al. [1] with a great
interest. In this article, the authors explained the situation of predicting the complexity of the
appendix by looking at analytical predictive factors. These easily accessible basic parameters
are very important, especially for physicians in rural areas or those who have difficulty in
accessing advanced imaging methods. In this regard, this study will make a significant
contribution to the literature. Howewer, some issues should be raised our point of view.
Firstly, Ribeiro et al. [1] emphasized the importance of basic laboratory parameters such as
complete blood count parameters (CBC) parameters and C-reactive protein (CRP). This basic
labaratory parameters are affected by various factors, like chronic diseases, haematological
diseases, allergic diseases, various drugs, malignant or inflammatory diseases [2,3].
Therefore, patients with diseases that may affect basic labaratory parameters should be
excluded from this study. Failure to exclude these patients from the study will lead to
misleading assessments.
Secondly, the patients were divided into two groups, but the negative appendectomy group
was not mentioned. Especially in pregnant patients, this rate (17.27-36%) may be higher and
this is a serious rate [4,5]. In this regard, negative appendectomy rate should be given in this
study, and the diagnostic value of analytical predictive factors should be used to determine the
negative appendectomy group. Again, as far as we understand, gangrenous appendicitis was
evaluated in the uncomplicated patient group. However, this patient group was evaluated in
the complicated appendicitis group in other studies [3,6]. This situation should be re-
evaluated.
Thirdly, to better understand the clinical characteristics of the patient groups, table 2 should
include important parameters such as co-morbid diseases, postoperative complications
according to the Clavien-Dindo classification [7], and cutt-off values of labaratory
parameters.
Finally, basic biochemical laboratory parameters, like CBC parameters, have high diagnostic
value in determining complicated or uncomplicated apendicitis. We found that white blood
cell, neutrophil, neutrophil to lymphocyte ratio, platelet, platelet to lymphocyte ratio, lactate
dehydrogenase, indirect, direct and total bilirubin can be utilized to diagnose complicated
appendicitis [5]. Therefore, using the basic biochemical parameters as well as CBC and CRP will make the study more valuable.
Provenance and peer review
Not commissioned, externally peer reviewed.Journal Pre-proof