Preoperative Prediction of Acute Appendicitis Pathological Type and Complicating Perforation Using IL-6 and IL-10

Abstract

Background:

This retrospective analysis investigated the role of serum IL-6 and IL-10 in distinguishing among pathological types of acute appendicitis and in preoperatively predicting perforation.

Methods:

The data from 376 patients were categorized into three groups on the basis of the definitive postoperative histopathological diagnosis: acute simple appendicitis (SIA), acute suppurative appendicitis (SA), and acute gangrenous appendicitis (GA). According to whether acute appendicitis is accompanied by perforation, the subjects are further stratified into two groups: non-perforated and perforated.

Results:

A statistically significant difference in IL-6 levels was observed among the groups (SIA vs. SA, p < 0.0001; SIA vs. GA, p < 0.0001; SA vs. GA, p < 0.0001). The IL-6 independently predicted a types of appendicitis pathology [SIA vs. SA: odds ratio (OR) 1.059, 95% confidence interval (CI) (1.039–1.079), p < 0.0001; SIA vs. GA: OR 1.080, 95% confidence interval (CI) (1.049–1.113), p < 0.0001; SA vs. GA: OR 1.000, 95% confidence interval (CI) (1.000–1.000), p = 0.05]. The optimum cut-off for the initial IL-6 was 23.54 [area under the curve (AUC) 0.8512, SIA vs. SA)], 39.36 (AUC 0.9844, SIA vs. GA), and 90.88 (AUC 0.8433, SA vs. GA). The IL-6 was significantly higher in the perforated group than in the non-perforated group (29.86 vs. 453.50, p < 0.001). The IL-6 independently predicted acute perforated appendicitis in multi-variable logistic regression analysis [OR 1.000, 95% confidence interval (CI) (1.000–1.000), p < 0.042]. The optimum cut-off for acute perforated appendicitis was 331.3 (AUC 0.8074). The diagnostic performance of IL-10 in differentiating acute appendicitis pathology types was fair (AUC 0.7322 for SIA vs. SA; 0.92263 for SIA vs. GA; 0.7738 for SA vs. GA) but consistently lower than IL-6, and its predictive value for acute perforated appendicitis remained limited (AUC 0.7875), further underscoring the superior discriminative capacity of IL-6.

Conclusions:

Preoperative evaluation of IL-6 and IL-10 can be useful in distinguishing pathological subtypes of acute appendicitis and predicting associated perforation.