Predictive value of serum sodium level in determining complicated appendicitis risk in children

Abstract

Introduction: Acute appendicitis is one of the most common surgical emergencies in childhood. Early recognition and treatment of children with complicated appendicitis, especially perforated and gangrenous, is very crucial. The aim of the present study was to determine the predictive value of simple blood tests, such as serum sodium (Na) level, C-reactive protein (CRP) level, and blood leukocyte and neutrophil counts, in complicated appendicitis. Methods: A total of 403 patients who underwent operation with the initial diagnosis of acute appendicitis that was confirmed by surgery and histopathology were evaluated retrospectively. Patients with perforated or gangrenous appendix, generalized peritonitis, and intra-abdominal abscess were identified as complicated appendicitis. Basal serum Na and CRP levels and blood leukocyte and neutrophil counts of patients with complicated and non-complicated appendicitis were compared. Results: Of the 403 patients, 158 (39.2%) had non-complicated, and 245 (60.8%) had complicated appendicitis. No difference was found between the two groups with regard to hyponatremia, leukocytosis, and neutrophilia (p>0.05). The risk of complicated appendicitis increased 2.5-fold in patients with elevated CRP (odds ratio: 2.498; 95% confidence interval: 1.558-4.004). Patients with complicated appendicitis had lower baseline serum Na levels (p=0.004; p<0.05). For diagnosis of complicated appendicitis, the cut-off value for Na was 138 mEq/L (sensitivity 82.5% and specificity 31.1%). Discussion and Conclusion: It was concluded that blood leukocyte and neutrophil counts in patients with suspected acute appendicitis in the emergency department were not helpful in determining the risk of complicated appendicitis. Although a basal serum Na level 138 mEq/L has a high sensitivity in predicting complicated appendicitis, its specificity is low.