Comparison of the Alvarado and AIR Scales in the diagnosis of acute appendicitis when associated with IL6 (interleukin 6) and NLI (neutrophil-lymphocyte index).

Abstract text (incl. references and figure legends)

Introduction: The diagnosis of acute appendicitis(AA) can be a challenge for young surgeons so several clinical tools have been developed seeking to optimize its diagnosis

Objectives: To comparatively evaluate the Alvarado and AIR scales in order to determine which one is more valid in the diagnosis of appendicitis. greater validity in the diagnosis of acute appendicitis (AA) alone and in association with IL 6 and NLI, in our population

Materials and methods: Prospective, comparative, observational study in patients with abdominal pain suggestive of AA who had their Alvarado, AIR, IL 6 and NLI values recorded over a period of 12 months and whose values were correlated with the final diagnosis of AA. A bivariate and multivariate analysis was performed for an OR with a 95% CI was performed using IBM SPSS Statistics v.26 and STATA v.14

Results: During the time of the study, data were collected from 139 patient.Bivariate analysis: AIR scale presents, for a score between 5-8, a PPV (positive predictive value) of 80%, sensitivity(S) of 85.3% and specificity(E) of 75%; in score ≥ 9 a PPV 89% with S 17%, E 98.4%. Presenting a ROC curve of 0.87 (CI: 8.81-0.93)

The Alvarado scale, for a score between 5-7, presents a PPV 66%, S 92%, E 45.3%, in scores ≥8 a PPV of 87.2%, S 45.3% and E 92%. It presented an ROC curve 0.8 (CI:0.73-0.87)

Multivariate analysis: Alvarado scale when associated with IL-6 the diagnostic yield is improved with an ROC curve of 0.849, while for AIR we did not evidence changes in its diagnostic yield (ROC curve: 0.86)

NLI when associated with the diagnostic scales did not present a statistically significant role

Conclusions:

- In our series, AIR scale has greater diagnostic validity to diagnose or exclude appendicitis compared to Alvarado scale

- By associating scores ≥ 5 on the Alvarado scale with IL-6, a significant increase in the diagnostic accuracy of AA is achieved

- NLI in association with diagnostic scales was not useful in our series

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