Evidence map›Paper›PMID 40825891›Full record

ArticleSurgical endoscopy2025

Complicated appendicitis: value of inflammatory markers based on EAES 2015 guidelines.

Maximilian Dölling, Michael Klös, Jonas Pachmann, Jessica Stockheim, Mirhasan Rahimli, Sara Al-Madhi, Ulf D Kahlert, Aristotelis Perrakis, Martin Herrmann, Roland S Croner and 1 more

Abstract read
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In one paragraph

Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Predictors of prolonged hospitalization and inflammation severity in acute appendicitis: a retrospective cohort study.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2026
    Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Maximilian DöllingFaculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany. maximilian.doelling@med.ovgu.de.
Michael KlösFaculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
Jonas PachmannFaculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
Jessica StockheimFaculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
Mirhasan RahimliFaculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
Sara Al-MadhiFaculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
Ulf D KahlertFaculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
Aristotelis PerrakisFaculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
Martin HerrmannFaculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
Roland S CronerFaculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
Mihailo AndricFaculty of Medicine, University Clinic for General-, Visceral-, Vascular- and Transplantation Surgery, Otto-Von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe clinical course of phlegmonous appendicitis (PHL) appears less severe than other complicated forms, which led to the discussion if PHL should be classified as complicated acute appendicitis (CAA). According to the guidelines of the European Association for Endoscopic Surgery (EAES) from 2015, PHL is classified as a CAA, which requires usually surgery. Therefore, this study aimed to evaluate the relevance of classifying PHL as CAA, with a focus on inflammatory markers, postoperative complications, and hospital length of stay.

methodsWe conducted a retrospective single-center study including 559 adult patients who underwent appendectomy between 2016 and 2020. Intraoperative classification followed the EAES 2015 guidelines. Preoperative C-reactive protein (CRP) and leucocyte counts were analyzed with respect to disease severity, postoperative complications, and length of hospital stay.

resultsComplicated appendicitis was diagnosed in 62.5% of patients, with phlegmonous appendicitis accounting for 30.8%. CRP levels were significantly higher in CAA than uncomplicated acute appendicitis (UAA; Median 48.4 vs. 8.8 mg/L; p < 0.001) and increased progressively with disease severity. CRP showed good diagnostic performance in distinguishing CAA from UAA (AUC: 0.76), whereas leucocyte count demonstrated limited diagnostic utility (AUC: 0.57). With suspected appendicitis at a CRP threshold of 52.5 mg/L, at least PHL could be expected (49% sensitivity, 95% specificity, AUC 0.72). The risk of postoperative complications was higher in all CAA subtypes, including PHL (adjusted OR: 2.3; p = 0.015). Elevated preoperative CRP levels were associated with both complications (p < 0.001) and prolonged hospital stay (IRR: 1.21 for PHL; p < 0.001). Leucocyte counts were neither predictive of complications nor hospital duration.

conclusionPhlegmonous appendicitis shows a distinct clinical profile with moderate CRP elevation, a 2.3-fold increased risk of postoperative complications, and a 21% increase in hospital stay. These findings support its classification under EAES 2015 guidelines as complicated appendicitis.

Indexed as

AppendectomyAppendicitisC-Reactive ProteinAdultAgedBiomarkersFemaleHumansLength of StayLeukocyte CountMaleMiddle AgedPostoperative ComplicationsPractice Guidelines as TopicRetrospective StudiesSeverity of Illness IndexBiomarkersC-Reactive ProteinComplicated acute appendicitisC-reactive proteinEAES classificationInflammatory biomarkersPhlegmonous appendicitisPostoperative morbidity

Identifiers

PMID40825891
PMCPMC12500825

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.