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Systemic and Tissue Inflammatory Biomarkers in Acute Appendicitis (STIBAA)

2026年11月3日 更新者:Ali Sürmelioğlu、Haydarpasa Numune Training and Research Hospital

Evaluation of Systemic and Tissue Level Inflammatory Response in Acute Appendicitis Using Multiple Biomarkers

This observational study aims to evaluate inflammatory responses in the blood and appendix tissue of adults diagnosed with acute appendicitis. Acute appendicitis is a common condition that often requires emergency surgery. Although clinical examinations, laboratory tests, and imaging methods are used for diagnosis, distinguishing uncomplicated from complicated appendicitis can sometimes be challenging.

The study aims to investigate whether inflammatory biomarkers measured in blood and appendix tissue are associated with the severity of acute appendicitis and whether these biomarkers may help improve the assessment of the disease.

The main questions this study aims to answer are:

  • How are inflammatory biomarkers in blood and appendix tissue associated with the severity of acute appendicitis?
  • Do these biomarkers differ between patients with uncomplicated and complicated acute appendicitis?
  • Are inflammatory biomarker levels associated with clinical findings and commonly used laboratory indicators? Approximately 140 adult patients diagnosed with acute appendicitis and undergoing appendectomy will be included in the study.

Participants will receive standard medical and surgical care. Blood samples obtained during routine clinical care and appendix tissue samples collected during surgery will be used for additional laboratory analyses. No additional invasive procedures or changes to standard treatment will be required for research purposes.

The findings may help researchers better understand inflammatory processes in acute appendicitis and identify biomarkers that could support clinical assessment and decision-making.

研究概览

地位

招聘中

详细说明

Background and Rationale:

Acute appendicitis is one of the most common causes of acute abdominal pain requiring emergency surgical intervention. Accurate assessment of disease severity, particularly the differentiation between uncomplicated and complicated acute appendicitis, remains an important clinical challenge.

Although clinical scoring systems, laboratory parameters, and imaging modalities contribute to diagnosis and clinical decision-making, their individual diagnostic performance may be limited. Systemic inflammatory markers, including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have been investigated as indicators of inflammatory activity. However, circulating inflammatory markers may not fully reflect the local inflammatory processes occurring within the appendix.

The simultaneous evaluation of systemic and tissue-level inflammatory biomarkers may provide a more comprehensive understanding of the inflammatory response in acute appendicitis and its relationship with disease severity.

Study Objective:

The primary objective of this prospective observational study is to evaluate systemic and tissue-level inflammatory responses in patients with acute appendicitis using multiple biomarkers.

The study will investigate the relationships between circulating inflammatory markers, local inflammatory biomarkers in appendix tissue, clinical findings, and the severity of acute appendicitis.

Study Design and Population:

This is a prospective, observational, single-center study conducted in the Department of General Surgery at Haydarpaşa Numune Training and Research Hospital, Istanbul, Türkiye.

Approximately 140 adult patients diagnosed with acute appendicitis and undergoing appendectomy will be enrolled according to the predefined eligibility criteria.

Patients will receive standard diagnostic evaluation and surgical treatment. No experimental therapeutic intervention or alteration of routine clinical management will be performed as part of the study.

Clinical Assessment:

Clinical and demographic information will be collected from eligible participants. Preoperative clinical evaluation will include the Alvarado Score and the Appendicitis Inflammatory Response (AIR) Score.

Clinical findings, routine laboratory results, imaging findings, operative observations, and histopathological examination results will be evaluated in relation to inflammatory biomarker measurements.

Biological Sample Collection and Biomarker Assessment:

Blood samples collected as part of routine clinical evaluation will be used for systemic inflammatory biomarker analysis. Serum or plasma obtained from these samples will be processed under appropriate laboratory conditions and stored at -80°C until analysis.

The systemic inflammatory parameters evaluated will include CRP, NLR, PLR, systemic inflammatory index, procalcitonin, ferritin, presepsin, erythrocyte sedimentation rate, CD68, cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), transforming growth factor-beta (TGF-β), calprotectin, and isoprostane.

Appendix tissue samples will be obtained from surgically removed specimens. Tissue collection will be performed without interfering with routine histopathological examination.

Tissue samples designated for biochemical analysis will be transported under cold-chain conditions, stored at -80°C, and homogenized using a standardized laboratory procedure.

Local inflammatory biomarkers assessed in appendix tissue will include presepsin, CD68, COX-2, iNOS, TGF-β, calprotectin, and isoprostane.

Statistical Analysis:

Statistical analyses will be performed using appropriate statistical software. The distribution of continuous variables will be assessed using the Kolmogorov-Smirnov or Shapiro-Wilk test. Normally distributed variables will be expressed as mean and standard deviation, whereas non-normally distributed variables will be presented as median and interquartile range.

Comparisons between groups will be performed using the independent-samples t-test or Mann-Whitney U test, as appropriate. Categorical variables will be analyzed using the chi-square test or Fisher's exact test.

For comparisons involving more than two groups, analysis of variance or the Kruskal-Wallis test will be used according to data distribution.

Correlations between inflammatory biomarkers and clinical scores will be assessed using Pearson or Spearman correlation analysis. Receiver operating characteristic (ROC) curve analysis will be used to evaluate the discriminatory performance of biomarkers for distinguishing complicated from uncomplicated acute appendicitis.

Multivariable logistic regression analysis will be considered to identify independent predictors of disease severity.

A p-value of less than 0.05 will be considered statistically significant.

Expected Scientific Contribution:

By evaluating circulating and tissue-level inflammatory biomarkers together, this study aims to provide a more comprehensive characterization of the inflammatory response in acute appendicitis.

The findings may contribute to identifying biomarkers associated with disease severity and may support future research on improved diagnostic assessment and clinical decision-making.

研究类型

观察性的

注册 (估计的)

60

联系人和位置

本节提供了进行研究的人员的详细联系信息,以及有关进行该研究的地点的信息。

学习联系方式

学习地点

    • Istanbul
      • Istanbul、Istanbul、土耳其(türkiye)、34668
        • 招聘中
        • Haydarpaşa Numune Training and Research Hospital
        • 接触:
        • 接触:
        • 副研究员:
          • Emre B Akçay

参与标准

研究人员寻找符合特定描述的人,称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。

资格标准

适合学习的年龄

18年 至 65年 (成人、年长者)

接受健康志愿者

不

有资格学习的性别

全部

取样方法

非概率样本

研究人群

Adult patients presenting to the General Surgery Department of Haydarpaşa Numune Training and Research Hospital with suspected acute appendicitis and scheduled for appendectomy will constitute the study population. Participants will be recruited consecutively from patients undergoing routine clinical and surgical care at this hospital.

描述

Inclusion Criteria:

Adults aged 18-65 years. Willingness to participate in the study and provision of written informed consent.

Suspected acute appendicitis based on clinical, laboratory, and/or imaging findings.

Scheduled for appendectomy following general surgical evaluation. Availability of an appendectomy specimen suitable for postoperative histopathological examination.

Availability of sufficient clinical and laboratory records for study evaluation.

Exclusion Criteria:

Age younger than 18 years or older than 65 years. Refusal to participate or failure to provide written informed consent. Presence of an active infection that may affect the systemic inflammatory response during the preoperative period.

Concomitant active infectious diseases, including pneumonia, urinary tract infection, or sepsis.

Chronic inflammatory or autoimmune diseases, including rheumatoid arthritis, inflammatory bowel disease, or systemic lupus erythematosus.

History of malignancy or active malignancy. Chronic renal failure or advanced liver failure. Use of immunosuppressive therapy. Use of corticosteroids, chemotherapy, or biological agents. Preoperative use of antibiotics or anti-inflammatory medications at a level that may significantly affect inflammatory biomarker measurements.

Pregnancy or breastfeeding. Identification of additional intra-abdominal pathology unrelated to appendicitis during appendectomy.

Failure to confirm acute appendicitis on postoperative histopathological examination.

Inadequate biological sample quantity or failure to store biological samples under appropriate conditions.

学习计划

本节提供研究计划的详细信息,包括研究的设计方式和研究的衡量标准。

研究是如何设计的?

设计细节

  • 观测模型:COHORT
  • 时间观点:PROSPECTIVE

队列和干预

团体/队列
干预/治疗
Patients Undergoing Appendectomy for Acute Appendicitis

This cohort includes adult patients undergoing appendectomy for acute appendicitis. Blood samples and appendix tissue specimens obtained during routine clinical care and surgery will be analyzed to evaluate systemic and tissue-level inflammatory biomarkers and their associations with clinical findings and disease severity. All participants will receive standard medical and surgical care without any research-related modifications to their treatment.

Patients diagnosed with acute appendicitis will undergo appendectomy as part of routine clinical care. The surgical procedure will be performed according to standard clinical indications and will not be assigned or modified by the study protocol. Blood samples and surgically removed appendix tissue specimens will be used for inflammatory biomarker analyses. No experimental surgical intervention or modification of standard treatment will be performed.

研究衡量的是什么?

主要结果指标

结果测量
措施说明
大体时间
Serum/Plasma Presepsin Levels
大体时间:Preoperatively, before appendectomy (single blood sampling).

Presepsin concentrations will be measured in preoperative peripheral venous blood samples using commercially available ELISA kits according to the manufacturer's instructions. Serum or plasma presepsin levels will be expressed in ng/mL (provisional unit, subject to confirmation based on the selected assay). The measurements will be used to evaluate systemic inflammatory responses and their association with the severity of acute appendicitis.

Preoperatively, before appendectomy (single blood sampling).
Appendix Tissue Presepsin Levels
大体时间:During appendectomy (single tissue collection).

Presepsin levels will be measured in appendix tissue homogenates prepared from surgically removed appendectomy specimens using commercially available ELISA kits according to the manufacturer's instructions. Results will be normalized to total tissue protein content and expressed in ng/mg total protein (provisional unit, subject to confirmation based on the selected assay and normalization method). The measurements will be used to evaluate local inflammatory responses and their association with the severity of acute appendicitis.

During appendectomy (single tissue collection).
Serum/Plasma CD68 Levels
大体时间:Preoperatively, before appendectomy (single blood sampling).

CD68 levels will be measured in preoperative peripheral venous blood samples using commercially available ELISA kits according to the manufacturer's instructions. Serum or plasma CD68 levels will be expressed in ng/mL (provisional unit, subject to confirmation based on the selected assay). The measurements will be used to evaluate systemic inflammatory responses and their association with the severity of acute appendicitis.

Preoperatively, before appendectomy (single blood sampling).
Appendix Tissue CD68 Levels
大体时间:During appendectomy (single tissue collection).

CD68 levels will be measured in appendix tissue homogenates prepared from surgically removed appendectomy specimens using commercially available ELISA kits according to the manufacturer's instructions. Results will be normalized to total tissue protein content and expressed in ng/mg total protein (provisional unit, subject to confirmation based on the selected assay and normalization method). The measurements will be used to evaluate local inflammatory responses and their association with the severity of acute appendicitis.

During appendectomy (single tissue collection).
Serum/Plasma COX-2 Levels
大体时间:Preoperatively, before appendectomy (single blood sampling).

Cyclooxygenase-2 (COX-2) levels will be measured in preoperative peripheral venous blood samples using commercially available ELISA kits according to the manufacturer's instructions. Serum or plasma COX-2 levels will be expressed in ng/mL (provisional unit, subject to confirmation based on the selected assay). The measurements will be used to evaluate systemic inflammatory responses and their association with the severity of acute appendicitis.

Preoperatively, before appendectomy (single blood sampling).
Appendix Tissue COX-2 Levels
大体时间:During appendectomy (single tissue sampling).

Cyclooxygenase-2 (COX-2) levels will be measured in appendix tissue homogenates prepared from surgically removed appendectomy specimens using commercially available ELISA kits according to the manufacturer's instructions. Results will be normalized to total tissue protein content and expressed in ng/mg total protein (provisional unit, subject to confirmation based on the selected assay and normalization method). The measurements will be used to evaluate local inflammatory responses and their association with the severity of acute appendicitis.

During appendectomy (single tissue sampling).
Serum/Plasma iNOS Levels
大体时间:Preoperatively, before appendectomy (single blood sampling).

Inducible nitric oxide synthase (iNOS) levels will be measured in preoperative peripheral venous blood samples using commercially available ELISA kits according to the manufacturer's instructions. Serum or plasma iNOS levels will be expressed in ng/mL (provisional unit, subject to confirmation based on the selected assay). The measurements will be used to evaluate systemic inflammatory responses and their association with the severity of acute appendicitis.

Preoperatively, before appendectomy (single blood sampling).
Appendix Tissue iNOS Levels
大体时间:During appendectomy (single tissue sampling).

Inducible nitric oxide synthase (iNOS) levels will be measured in appendix tissue homogenates prepared from surgically removed appendectomy specimens using commercially available ELISA kits according to the manufacturer's instructions. Results will be normalized to total tissue protein content and expressed in ng/mg total protein (provisional unit, subject to confirmation based on the selected assay and normalization method). The measurements will be used to evaluate local inflammatory responses and their association with the severity of acute appendicitis.

During appendectomy (single tissue sampling).
Serum/Plasma TGF-β Levels
大体时间:Preoperatively, before appendectomy (single blood sampling).

Transforming growth factor-beta (TGF-β) levels will be measured in preoperative peripheral venous blood samples using commercially available ELISA kits according to the manufacturer's instructions. Serum or plasma TGF-β levels will be expressed in ng/mL (provisional unit, subject to confirmation based on the selected assay). The measurements will be used to evaluate systemic inflammatory responses and their association with the severity of acute appendicitis.

Preoperatively, before appendectomy (single blood sampling).
Appendix Tissue TGF-β Levels
大体时间:During appendectomy (single tissue sampling).

Transforming growth factor-beta (TGF-β) levels will be measured in appendix tissue homogenates prepared from surgically removed appendectomy specimens using commercially available ELISA kits according to the manufacturer's instructions. Results will be normalized to total tissue protein content and expressed in ng/mg total protein (provisional unit, subject to confirmation based on the selected assay and normalization method). The measurements will be used to evaluate local inflammatory responses and their association with the severity of acute appendicitis.

During appendectomy (single tissue sampling).
Serum/Plasma Calprotectin Levels
大体时间:Preoperatively, before appendectomy (single blood sampling).

Calprotectin concentrations will be measured in preoperative peripheral venous blood samples using commercially available ELISA kits according to the manufacturer's instructions. Serum or plasma calprotectin levels will be expressed in ng/mL (provisional unit, subject to confirmation based on the selected assay). The measurements will be used to evaluate systemic inflammatory responses and their association with the severity of acute appendicitis.

Preoperatively, before appendectomy (single blood sampling).
Appendix Tissue Calprotectin Levels
大体时间:During appendectomy (single tissue sampling).

Calprotectin concentrations will be measured in appendix tissue homogenates prepared from surgically removed appendectomy specimens using commercially available ELISA kits according to the manufacturer's instructions. Results will be normalized to total tissue protein content and expressed in ng/mg total protein (provisional unit, subject to confirmation based on the selected assay and normalization method). The measurements will be used to evaluate local inflammatory responses and their association with the severity of acute appendicitis.

During appendectomy (single tissue sampling).
Serum/Plasma Isoprostane Levels
大体时间:Preoperatively, before appendectomy (single blood sampling).

Isoprostane levels will be measured in preoperative peripheral venous blood samples using commercially available ELISA kits according to the manufacturer's instructions. Serum or plasma isoprostane levels will be expressed in ng/mL (provisional unit, subject to confirmation based on the selected assay). The measurements will be used to evaluate systemic oxidative stress responses and their association with the severity of acute appendicitis.

Preoperatively, before appendectomy (single blood sampling).
Appendix Tissue Isoprostane Levels
大体时间:During appendectomy (single tissue sampling).

Isoprostane levels will be measured in appendix tissue homogenates prepared from surgically removed appendectomy specimens using commercially available ELISA kits according to the manufacturer's instructions. Results will be normalized to total tissue protein content and expressed in ng/mg total protein (provisional unit, subject to confirmation based on the selected assay and normalization method). The measurements will be used to evaluate local oxidative stress responses and their association with the severity of acute appendicitis.

During appendectomy (single tissue sampling).

次要结果测量

结果测量
措施说明
大体时间
White Blood Cell Count
大体时间:Preoperatively, before appendectomy (single blood sampling).

White blood cell count will be obtained from routine preoperative complete blood count results recorded in hospital laboratory records. Values will be expressed as ×10³/µL and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
Absolute Neutrophil Count
大体时间:Preoperatively, before appendectomy (single blood sampling).

Absolute neutrophil count will be obtained from routine preoperative complete blood count results recorded in hospital laboratory records. Values will be expressed as ×10³/µL and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
Absolute Lymphocyte Count
大体时间:Preoperatively, before appendectomy (single blood sampling).

Absolute lymphocyte count will be obtained from routine preoperative complete blood count results recorded in hospital laboratory records. Values will be expressed as ×10³/µL and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
Platelet Count
大体时间:Preoperatively, before appendectomy (single blood sampling).

Platelet count will be obtained from routine preoperative complete blood count results recorded in hospital laboratory records. Values will be expressed as ×10³/µL and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
Hemoglobin Concentration
大体时间:Preoperatively, before appendectomy (single blood sampling).

Hemoglobin concentration will be obtained from routine preoperative complete blood count results recorded in hospital laboratory records. Values will be expressed in g/dL and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
Hematocrit
大体时间:Preoperatively, before appendectomy (single blood sampling).

Hematocrit will be obtained from routine preoperative complete blood count results recorded in hospital laboratory records. Values will be expressed as a percentage (%) and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
C-Reactive Protein (CRP) Concentration
大体时间:Preoperatively, before appendectomy (single blood sampling).

Preoperative C-reactive protein (CRP) concentration will be obtained from routine hospital laboratory records. Values will be expressed in mg/L and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
Procalcitonin Concentration
大体时间:Preoperatively, before appendectomy (single blood sampling).

Preoperative procalcitonin concentration will be obtained from available routine hospital laboratory records. Values will be expressed in ng/mL and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
Ferritin Concentration
大体时间:Preoperatively, before appendectomy (single blood sampling).

Preoperative ferritin concentration will be obtained from available routine hospital laboratory records. Values will be expressed in ng/mL and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
Erythrocyte Sedimentation Rate (ESR)
大体时间:Preoperatively, before appendectomy (single blood sampling).

Preoperative erythrocyte sedimentation rate (ESR) will be obtained from available routine hospital laboratory records. Values will be expressed in mm/hour and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
Neutrophil-to-Lymphocyte Ratio (NLR)
大体时间:Preoperatively, before appendectomy (single blood sampling).

The neutrophil-to-lymphocyte ratio (NLR) will be calculated by dividing the absolute neutrophil count by the absolute lymphocyte count obtained from routine preoperative complete blood count results. NLR will be reported as a dimensionless ratio and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
Platelet-to-Lymphocyte Ratio (PLR)
大体时间:Preoperatively, before appendectomy (single blood sampling).

The platelet-to-lymphocyte ratio (PLR) will be calculated by dividing the platelet count by the absolute lymphocyte count obtained from routine preoperative complete blood count results. PLR will be reported as a dimensionless ratio and evaluated in relation to acute appendicitis severity and experimental inflammatory biomarker levels.

Preoperatively, before appendectomy (single blood sampling).
Systemic Immune-Inflammation Index (SII)
大体时间:Preoperatively, before appendectomy (single blood sampling).

The systemic immune-inflammation index (SII) will be calculated as platelet count multiplied by absolute neutrophil count and divided by absolute lymphocyte count, using routine preoperative complete blood count results. Cell counts will be expressed in ×10³/µL for calculation, and SII will be reported in ×10³/µL. Associations with acute appendicitis severity and experimental inflammatory biomarker levels will be evaluated.

Preoperatively, before appendectomy (single blood sampling).
Alvarado Score
大体时间:Preoperatively, before appendectomy (single clinical assessment).

The Alvarado score will be calculated using preoperative clinical findings and laboratory parameters. The total score ranges from 0 to 10 points, with higher scores indicating a greater clinical likelihood of acute appendicitis. Associations between the score and experimental inflammatory biomarker levels will be evaluated.

Preoperatively, before appendectomy (single clinical assessment).
Appendicitis Inflammatory Response (AIR) Score
大体时间:Preoperatively, before appendectomy (single clinical assessment).

The Appendicitis Inflammatory Response (AIR) score will be calculated using preoperative clinical findings and laboratory parameters. The total score ranges from 0 to 12 points, with higher scores indicating a greater clinical likelihood of acute appendicitis. Associations between the score and experimental inflammatory biomarker levels will be evaluated.

Preoperatively, before appendectomy (single clinical assessment).
Incidence of Postoperative Complications
大体时间:From appendectomy through postoperative day 30.

The occurrence of postoperative complications following appendectomy will be assessed using hospital medical records. The outcome will be reported as the number and percentage of patients experiencing at least one postoperative complication during the predefined follow-up period.

From appendectomy through postoperative day 30.

合作者和调查者

在这里您可以找到参与这项研究的人员和组织。

调查人员

  • 研究主任:Ali Sürmelioğlu、Haydarpasa Numune Training and Research Hospital

出版物和有用的链接

负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。

研究记录日期

这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查,以确保它们在发布到公共网站之前符合特定的质量控制标准。

研究主要日期

学习开始 (实际的)

2026年7月12日

初级完成 (估计的)

2027年1月12日

研究完成 (估计的)

2027年5月27日

研究注册日期

首次提交

2026年10月23日

首先提交符合 QC 标准的

2026年11月3日

首次发布 (实际的)

2026年11月9日

研究记录更新

最后更新发布 (实际的)

2026年11月9日

上次提交的符合 QC 标准的更新

2026年11月3日

最后验证

2026年11月1日

更多信息

与本研究相关的术语

计划个人参与者数据 (IPD)

计划共享个人参与者数据 (IPD)?

不

IPD 计划说明

Individual participant data will not be shared with external researchers. Clinical, laboratory, and histopathological data will be coded and securely stored to protect participant confidentiality. Access to individual-level data will be restricted to the authorized research team. Study findings will be reported in aggregate form without disclosing identifiable participant information.

药物和器械信息、研究文件

研究美国 FDA 监管的药品

不

研究美国 FDA 监管的设备产品

不

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