title: Diagnostic value of hyperfibrinogenemia as a predictive factor for appendiceal perforation in acute appendicitis.
abstract: BACKGROUND
  Acute appendicitis is one of the most common emergency requiring operation. As the first discovered coagulation factor, plasma fibrinogen frequently increases with inflammation due to the activation of coagulation. The aim of this retrospective study was to investigate the diagnostic value of hyperfibrinogenemia as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis.
  
  
  METHODS
  We identified 455 patients (202 females, 253 males; mean age, 31.7 years) with histologically confirmed acute appendicitis who underwent laparoscopic or open appendectomy. Results of preoperative laboratory values and post-operative histologic results were analysed retrospectively. A multivariate logistic regression model was performed to determine patient's age and laboratory tests associated with perforated appendicitis.
  
  
  RESULTS
  Mean plasma fibrinogen level of all patients was 3.99 g/L (1.41 SD; range, 1.73-10.6 g/L; median, 3.69 g/L). Patients with appendiceal perforation had a mean fibrinogen level of 5.72 g/L (1.52 SD; range, 3.38-10.04 g/L; median, 5.28 g/L), which was significantly higher than those with nonperforated groups (P = 0.001). Multivariate analysis showed fibrinogen and D-dimer were associated with perforation (P = 0.001, P = 0.014, respectively). Areas under the receiver operating characteristic curve of fibrinogen for discriminating acute perforated appendicitis from non-perforated groups were larger than white blood cell and D-dimer.
  
  
  CONCLUSIONS
  Hyperfibrinogenemia was common in patients with acute appendicitis and fibrinogen may be useful as a predictive factor for appendiceal perforation.
authors.affiliation: Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Lingling
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China.
authors.forename: Shaoguang
authors.initials: S
authors.lastname: Feng
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Songsong
authors.initials: S
authors.lastname: Huang
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Yulong
authors.initials: Y
authors.lastname: Tong
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Zhongliang
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Wu
authors.affiliation: Institute of Inflammation and Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Institute of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Xin-He
authors.initials: XH
authors.lastname: Lai
authors.affiliation: Department of Pediatric Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Institute of Inflammation and Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Institute of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Chen
mesh_terms: D000208:Acute Disease; D000328:Adult; D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000097:blood* / Q000150:complications / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000378:metabolism; D007416:Intestinal Perforation / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D010535:Laparoscopy / Q000379:methods; D007958:Leukocyte Count / Q000379:methods; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen
keywords: appendiceal perforation; diagnosis; hyperfibrinogenemia