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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Relationship between peripheral blood endotoxin, toll-like receptor 4 expression, and postoperative infection following surgery for acute appendicitis
Wei Su, Tao Yang, Xiao-Jun Hu, Juan Song, Jing-Jing He, Dan Huang, Bo Zhang, Xiao-Ji Zhao, Fang Tang
Wei Su, Xiao-Jun Hu, Dan Huang, Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine of University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
Tao Yang, Juan Song, Jing-Jing He, Department of Clinical Laboratory, Santai Country People’s Hospital, Mianyang 621100, Sichuan Province, China
Bo Zhang, Fang Tang, Department of Nuclear Medicine, The Second Affiliated Hospital of Chengdu Medical College, Nuclear Industry 416 Hospital, Chengdu 610083, Sichuan Province, China
Xiao-Ji Zhao, Department of Clinical Laboratory, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, Sichuan Province, China
Co-first authors: Wei Su and Tao Yang.
Co-corresponding authors: Xiao-Ji Zhao and Fang Tang.
Author contributions: Su W and Yang T contributed equally as co-first authors; Zhao XJ and Tang F contributed equally as co-corresponding authors; Su W performed the majority of the experiments and wrote the manuscript; Hu XJ and Huang D designed the study and corrected the manuscript; Yang T was involved in analytical tools; Song J and He JJ participated in the collection of human material; Zhang B and Zhao XJ served as scientific advisors and participated in the collection of human material; Tang F was the guarantor.
Institutional review board statement: The study was approved by the Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Fang Tang, Department of Nuclear Medicine, The Second Affiliated Hospital of Chengdu Medical College, Nuclear Industry 416 Hospital, No. 4 North Fourth Section, Second Ring Road, Chengdu 610083, Sichuan Province, China.
tangfangtf85@163.com
Received: December 27, 2024
Revised: January 25, 2025
Accepted: February 24, 2025
Published online: April 27, 2025
Processing time: 91 Days and 23.6 Hours
BACKGROUND
Acute appendicitis, a common condition with a higher prevalence among men, has shown an increasing incidence in recent years owing to lifestyle changes. It is characterized by right lower quadrant abdominal pain, rebound tenderness, and rapid onset. Its pathogenesis is complex and potentially linked to infection, environment, and genetics. Timely intervention is crucial to prevent complications. While surgery is the primary treatment, it carries risks, including postoperative infections that may necessitate re-operation. Gram-negative bacteria release endotoxin (ETX), which induces inflammation and is recognized by toll-like receptor 4 (TLR4). This study evaluated ETX and TLR4 levels in patients with acute appendicitis to assess the risk of postoperative incision infections, aiding in prevention and treatment.
AIM
To explore ETX and TLR4 expression in the blood of patients with acute appendicitis and its association with in postoperative incision infection.
METHODS
A total of 153 patients with acute appendicitis treated at our hospital between April 2022 and March 2024 (n = 153) were included in the study. Patients were categorized into infected (n = 36) and uninfected (n = 117) groups according to the development of postoperative incision infections. General characteristics and blood levels of ETX and TLR4 were compared, and the factors influencing postoperative infection were identified using multivariate logistic regression. ETX and TLR4 predictive values were analyzed using receiver operating characteristic curves.
RESULTS
No statistically significant differences were observed between the two groups in terms of sex, age, or other general characteristics (P > 0.05). Compared to the uninfected group, the infected group had a higher proportion of patients with suppurative or gangrenous appendicitis, longer surgical times, longer incision lengths, and elevated ETX and TLR4 levels (P < 0.05). Multivariate logistic regression analysis identified pathological type, surgical method, surgical time, and incision length as factors influencing postoperative incision infection in acute appendicitis. Receiver operating characteristic curve analysis revealed that both ETX and TLR4 levels were predictive factors for postoperative incision infection, with higher prediction efficiency when combined.
CONCLUSION
Pathological type, surgical method, surgical time, and incision length significantly influence postoperative incision infection risk in patients with acute appendicitis. Elevated ETX and TLR4 levels serve as valuable predictors of post-appendectomy infections.
Core Tip: Clinical data from patients with acute appendicitis, with and without postoperative incision infections, were compared to analyze factors influencing incision infection. This study explored gram-negative bacteria release endotoxin and toll-like receptor 4 expression in the blood of patients with acute appendicitis, and identified reliable indicators for predicting postoperative incision infections. Pathological type, surgical method, surgical time, and incision length are significant factors influencing the postoperative incision infection risk.
