The Role of Clinical and Inflammatory Parameters to Predict the Success of Medical Treatment in Patients with Tuboovarian Abscess

Objective: To examine the role of hematological inflammation markers and clinical findings on the day of hospitalization in predicting medical treatment failure in patients with tubo-ovarian abscess (TOA). Methods: A total of 49 patients with TOA who were hospitalized in our hospital were included in this study. The patients whose clinical findings, biochemical inflammation-related markers or radiological findings that did not improve despite the medical treatment and surgery or minimally-invasive drainage performed were enrolled into the medical treatment failure group (n=12). Demographic data (age, weight, gravidity, parity, abortion, presence of abdominal guarding, rebound, vaginal discharge, cervical motion tenderness, fever, length of stay), laboratory results [C-reactive protein (CRP), procalcitonin, white blood cell count, neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio] and radiological reports (abscess size) of the patients on the day of hospitalization were obtained from hospital records. Results: Cervical motion tenderness, CRP levels and the length of stay of the medical failure group were higher than successful medical treatment group on the day of hospitalization (p<0.05 for all). CRP level had diagnostic adequacy in predicting the success of medical treatment of TOA (AUC =0.71, p=0.03). At the time of admission, CRP level <144 mg/L had 88.2% positive predictive value (PPV). The absence of cervical motion tenderness with CRP <144 mg/L had 100% PPV in prediction of the success of the medical treatment of TOA (AUC =0.77, p=0.006). Conclusion: The absence of cervical motion tenderness and the CRP level on the day of hospitalization may predict the success of medical treatment in TOA.