{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T02:45:31Z","timestamp":1781059531050,"version":"3.54.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":30,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015738","name":"Mary and Georg C. Ehrnrooth Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006306","name":"Sigrid Juselius Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006306","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002341","name":"Finnish Academy","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100007083","name":"Orion Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007083","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Gastroenterological Research Foundation"},{"DOI":"10.13039\/100008723","name":"Finnish Medical Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008723","id-type":"DOI","asserted-by":"publisher"}]},{"name":"EVO Foundation"},{"DOI":"10.13039\/501100011797","name":"Turku University Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011797","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100022793","name":"Turku University Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022793","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Antibiotics are safe and efficient for CT-diagnosed uncomplicated acute appendicitis. Identifying predictive factors of primary non-responsiveness or recurrence would further improve antibiotic treatment success and safety.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All patients treated with antibiotics in two large RCTs (APPAC and APPAC II) were included. The primary non-responsiveness analysis compared patients operated on within 30 days after randomization for complicated appendicitis with either patients presenting with uncomplicated appendicitis at surgery within 30 days or patients with successful antibiotic treatment during 3-year follow-up. Prognostic factors for appendicitis recurrence were assessed by comparing patients with successful antibiotic treatment with patients with acute appendicitis operated on after 30 days of initial antibiotics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 856 patients randomized to antibiotics (mean(s.d.) age of 36(12) years; 365 (42.6%) were women), 832 were eligible for non-responsiveness analysis and 732 for appendicitis recurrence analysis. Findings associated with primary non-responsiveness on admission included an appendiceal diameter \u226515\u2005mm (adjusted risk ratio (RR) 4.00 (95% c.i. 2.00 to 7.92) (P &amp;lt; 0.001)) and a body temperature &amp;gt;38\u00b0C (adjusted RR 2.76 (95% c.i. 1.27 to 6.03) (P = 0.011)). During the first 6\u201330\u2005h after admission, C-reactive protein (CRP) \u2265100\u2005mg\/l (negative predictive value of 99%) and leucocyte count \u22659 \u00d7 109\/l were associated with primary non-responsiveness (adjusted RR 8.29 (95% c.i. 3.69 to 18.63) (P &amp;lt; 0.001) and adjusted RR 4.44 (95% c.i. 1.79 to 11.05) (P = 0.001) respectively). No prognostic findings for appendicitis recurrence were identified.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Patients with an appendiceal diameter \u226515\u2005mm and a body temperature &amp;gt;38\u00b0C may not be optimal candidates for non-operative treatment for uncomplicated acute appendicitis. Patients with CRP &amp;lt;100\u2005mg\/l at 24\u2005h of antibiotic treatment for uncomplicated acute appendicitis have a 99% likelihood of successful antibiotic therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Registration numbers<\/jats:title>\n                  <jats:p>NCT03236961 and NCT01022567 (http:\/\/www.clinicaltrials.gov).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjs\/znaf143","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T09:00:46Z","timestamp":1753952446000},"source":"Crossref","is-referenced-by-count":4,"title":["Prognostic factors associated with primary non-responsiveness to antibiotics and appendicitis recurrence for CT-diagnosed uncomplicated acute appendicitis: secondary analysis of two randomized clinical trials"],"prefix":"10.1093","volume":"112","author":[{"given":"Liisa","family":"Sel\u00e4nne","sequence":"first","affiliation":[{"name":"Division of Digestive Surgery and Urology, Turku University Hospital , Turku ,","place":["Finland"]},{"name":"Department of Surgery, University of Turku , Turku ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saija","family":"Hurme","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Turku and Turku University Hospital , Turku ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suvi","family":"Sippola","sequence":"additional","affiliation":[{"name":"Department of Surgery, Helsinki University Hospital , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tero","family":"Rautio","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oulu University Hospital , Oulu ,","place":["Finland"]},{"name":"Medical Research Centre Oulu, University of Oulu , Oulu ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Nordstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere ,","place":["Finland"]},{"name":"Faculty of Medicine and Health Technology, University of Tampere , Tampere ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuomo","family":"Rantanen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kuopio University Hospital , Kuopio ,","place":["Finland"]},{"name":"Department of Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarja","family":"Pinta","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sein\u00e4joki Central Hospital , Sein\u00e4joki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imre","family":"Ilves","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mikkeli Central Hospital , Mikkeli ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Mattila","sequence":"additional","affiliation":[{"name":"Department of Surgery, Wellbeing Services County of Central Finland\/Hospital Nova of Central Finland , Jyv\u00e4skyl\u00e4 ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eeva-Liisa","family":"S\u00e4vel\u00e4","sequence":"additional","affiliation":[{"name":"Department of Surgery, Satakunta Central Hospital , Pori ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jukka","family":"Rintala","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oulu University Hospital , Oulu ,","place":["Finland"]},{"name":"Department of 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,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6435-9264","authenticated-orcid":false,"given":"Paulina","family":"Salminen","sequence":"additional","affiliation":[{"name":"Division of Digestive Surgery and Urology, Turku University Hospital , Turku ,","place":["Finland"]},{"name":"Department of Surgery, University of Turku , Turku ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"2025073105004306900_znaf143-B1","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/S0140-6736(15)00275-5","article-title":"Acute appendicitis: modern understanding of pathogenesis, diagnosis, and 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