Анализ результатов диагностики и прогнозирования острого аппендицита у беременных: подходы к решению известной клинической проблемы: ОРИГИНАЛЬНЫЕ СТАТЬИ

Лариса Алексеевна Логвин; Дмитрий Николаевич Попов; Елена Владимировна Киселева; Андрей Юрьевич Корольков; Сергей Федорович Багненко

doi:10.56871/

Analyzing results of diagnostics and prediction of acute appendicitis in pregnant women: approaches to solving a well-known clinical problem

ORIGINAL STUDIES

Larisa A. Logvin Academician I.P. Pavlov First St. Petersburg State Medical University https://orcid.org/0009-0008-4997-9543
Dmitry N. Popov Academician I.P. Pavlov First St. Petersburg State Medical University https://orcid.org/0000-0001-6995-4601
Elena V. Kiseleva Academician I.P. Pavlov First St. Petersburg State Medical University https://orcid.org/0000-0002-2830-1687
Andrey Yu. Korolkov Academician I.P. Pavlov First St. Petersburg State Medical University https://orcid.org/0000-0001-7449-6908
Sergey F. Bagnenko Academician I.P. Pavlov First St. Petersburg State Medical University https://orcid.org/0000-0002-6380-137X

Keywords:

acute appendicitis pregnancy appendectomy acute surgical pathology diagnosis острый аппендицит беременность аппендэктомия острая хирургическая патология диагностика

Abstract

BACKGROUND: Currently, despite the development of modern technologies, timely diagnosis of acute appendicitis in pregnant women still remains an important task. Early and correct diagnosis makes it possible to determine the necessary tactics and treatment, which minimizes possible complications and negative results of surgical interventions.

AIM: The aim of the study was to analyze medical histories and find a new approach in the diagnosis and treatment of acute appendicitis in pregnant women in the second and third trimesters of pregnancy.

MATERIALS AND METHODS: A retrospective analysis of medical records of pregnant patients (n=162) operated on with a diagnosis of acute appendicitis in the period from 2010 to 2019 was carried out. The study took into account epidemiological, clinical, paraclinical, operational and postoperative data. Statistical processing of the obtained data was
carried out.

RESULTS: When conducting a comparative analysis, the most significant predictors of acute appendicitis in pregnant women were identified: the level of leukocytes in the blood ≥12.5×109/l [relative risk (RR) (confidence interval (CI)) 2.37 (1.47–3.80)], C-reactive protein ≥21.0 mg/l [RR (CI) 1.72 (1.36–2.17)], positive Kocher’s sign [RR (CI) 2.01 (1.50–2.69)], and percentage granulocyte count ≥78.0 [RR (CI) 2.2 (1.29–3.77)], and presence of nausea/vomiting [RR (CI) 1.35 (1.03–1.76)].
Based on the obtained data from univariate analysis, a decision tree diagram was developed to determine the risk of developing acute appendicitis. The proposed decision tree diagram has good sensitivity (65.9%) and specificity (92.1%) with Au ROC=0.86.

CONCLUSIONS: The constructed diagnostic model can be used in clinical practice to determine the likelihood of acute appendicitis in pregnant women in the II–III trimesters of pregnancy, and the inclusion of magnetic resonance imaging can significantly improve the quality of acute appendicitis diagnosis, which requires further research in this direction.

Author Biographies

Larisa A. Logvin, Academician I.P. Pavlov First St. Petersburg State Medical University

Surgeon of Surgical Department No. 4
(emergency surgery) of the Research Institute of Surgery and Emergency Medicine, Academician I.P. Pavlov First
St. Petersburg State Medical University

Dmitry N. Popov, Academician I.P. Pavlov First St. Petersburg State Medical University

MD, Ph D, Assistant of the F.G. Uglov
Hospital Surgery Department No. 2 with Clinic, Head of the Surgical Department No. 4 (emergency surgery) of the Research Institute of Surgery and Emergency Medicine,
Academician I.P. Pavlov First St. Petersburg State Medical University, Saint Petersburg, Russia

Elena V. Kiseleva, Academician I.P. Pavlov First St. Petersburg State Medical University

MD, Ph D, Surgeon,
Surgeon of Surgical Department No. 4 (emergency surgery)
of the Research Institute of Surgery and Emergency Medicine, Academician I.P. Pavlov First St. Petersburg State Medical University

Andrey Yu. Korolkov, Academician I.P. Pavlov First St. Petersburg State Medical University

MD, Ph D, Dr. Sci. (Medicine), Professor, Head of the F.G. Uglov Hospital Surgery Department No. 2 with Clinic, Head of the Department of General and Emergency Surgery of the Research Institute of Surgery and Emergency Medicine, Academician I.P. Pavlov First St. Petersburg State Medical University

Sergey F. Bagnenko, Academician I.P. Pavlov First St. Petersburg State Medical University

MD, Ph D, Dr. Sci. (Medicine),
Professor, Academician of the Russian Academy of Sciences, Rector, Academician I.P. Pavlov First St. Petersburg State Medical University

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