It is very difficult to diagnose AA in pregnant women due to the difficulty of differentiating nonspecific symptoms, including vomiting and abdominal pain, from pregnancy-related conditions. Diagnosis of AA requires laboratory tests and imaging methods in addition to medical history and physical examination. However, the use of imaging methods is limited due to the potential harmful effects on the fetus. In conclusion, the morbidity and mortality rates for both the mother and the fetus increase as a result of delayed AA diagnosis, especially in pregnant patients. Therefore, cost-effective, rapid, powerful, and easily accessible markers are required for the diagnosis of AA in pregnant women. Upon literature review, no study suggested the importance of SIII in the diagnosis of pregnant AA, to the best of our knowledge. To the best of our knowledge, this is the first study in pregnant patients with AA, and we believe that SIII may serve as a guide for clinicians in both the diagnosis of AA and in determining complicated appendicitis.
The mean age of the pregnant patients included in our study was 28.16 ± 5.03 years. In a previous study of 42 patients who underwent appendectomy during pregnancy, the mean age was found to be 30 ± 6 years (19). Another study reported a mean age of 25.5 ± 6.4 years for pregnant patients diagnosed with AA (20). The mean age of the patient group in this study was similar to that reported in the literature, especially considering that it consisted of patients of childbearing age. The average age may vary due to differences in the effectiveness of women in business life based on socio-cultural characteristics and development levels in different countries.
In this study, SIII was significantly higher in patients diagnosed with AA compared with the control group. There is no study in the literature in which SIII was specifically used for the diagnosis of AA during pregnancy. Duyan et al. (21) reported that SIII could be used in the diagnosis of AA in adult patients. Another study reported that SIII was significantly higher for predicting AA (22). In a study by Tekeli et al. with pediatric patients, it was similarly reported that SIII could be used for the diagnosis of AA (13). Patients with AA develop progressive inflammation that is induced as a result of obstruction of the appendix. SIII levels are elevated due to increased inflammation. SIII can be used as a good marker of inflammation.
In the present study, SIII significantly differentiated between complicated appendicitis and uncomplicated appendicitis in pregnant patients diagnosed with AA. Upon a literature review, no study used SIII in the diagnosis of complicated appendicitis in pregnant patients with AA. In a study by Tekeli et al. on patients with pediatric appendicitis, it was reported that SIII was significant in predicting complicated appendicitis in children (13). SIII can be used in the diagnosis of complicated appendicitis because the level of inflammation is higher in pregnant patients with complicated appendicitis associated with delay in diagnosis due to anatomical and physiologic reasons.
In this study, the cut-off value of SIII for the diagnosis of AA in pregnant patients was 1330.66 with a sensitivity and specificity of 68.4% and 81.6%, respectively. In addition, the cut-off value of SIII in the diagnosis of complicated appendicitis in our study was 2301.66 and its sensitivity and specificity were 66.7% and 91.3%, respectively. A previous study that investigated the diagnostic value of SIII in AA reported that its sensitivity and specificity were 78.3% and 95.33%, respectively, with a cut-off value of 923 (20). In a study with adult patients, the cut-off value of SIII was determined to be 651.47, with a sensitivity and specificity of 95% and 98%, respectively (22). In a study by Tekeli et al., the cut-off value of SIII was 2358.53 in the diagnosis of complicated appendicitis, with a sensitivity and specificity of 56.4% and 67.6% (13). Consistent with the limited literature, in this study, SIII was diagnostically significant in acute and complicated appendicitis. Changes in hormonal balance associated with physiologic changes in pregnant women may cause differences in laboratory test results; therefore, sensitivity and specificity may differ.
SIII is useful as a diagnostic marker in the diagnosis of AA and complicated appendicitis in pregnant patients, especially because SIII is affected in the early phase of the inflammation process as a result of a combination of several inflammatory parameters. In addition, the use of SIII will accelerate the diagnostic process of AA in pregnant patients and provide early diagnosis.