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Serum Soluble CD40 Ligand in Predicting Simple Appendicitis and Complicated Appendicitis at Different Time Points in
Wun-Yan Huang1,2, Chun-Yu Chen1,2, Yu-Jun Chang3
1Department of Pediatric Emergency Medicine, Children Hospital, China Medical University, Taichung, Taiwan.
Insights
Serum soluble CD40 ligand (sCD40L) effectively distinguishes simple, gangrenous, and ruptured appendicitis in children. This inflammatory biomarker offers a promising alternative to radiation-heavy imaging for diagnosing pediatric appendicitis.
Area of Science:
- Pediatric Surgery
- Biomarker Discovery
- Diagnostic Imaging
Background:
- Appendicitis is a frequent pediatric surgical emergency.
- Differentiating simple, gangrenous, and ruptured appendicitis is clinically challenging.
- Current diagnostic methods like CT scans involve radiation exposure.
Purpose of the Study:
- To evaluate serum soluble CD40 ligand (sCD40L) as a biomarker for distinguishing appendicitis severity in children.
- To compare sCD40L levels across normal appendix, simple appendicitis (SA), gangrenous appendicitis (GA), and ruptured appendicitis (RA) groups.
Main Methods:
- Serum sCD40L levels were measured in pediatric patients (<18 years) with suspected appendicitis within 72 hours of symptom onset.
- sCD40L levels were analyzed on days 1, 2, and 3 post-symptom onset across nine subgroups (normal appendix, SA, GA, RA).
- Diagnostic performance, including sensitivity and specificity, was assessed using receiver operating characteristic (ROC) curves.
Main Results:
- Significant differences in sCD40L levels were observed for SA on day 2, GA on days 2-3, and RA on days 1-3.
- The optimal cutoff for sCD40L was 178 pg/mL, yielding sensitivity ranging from 0.75 to 1.00 and specificity of 0.90.
- sCD40L demonstrated strong predictive value for appendicitis and its subtypes.
Conclusions:
- Serum sCD40L is a valuable and accurate biomarker for diagnosing pediatric appendicitis.
- sCD40L can effectively differentiate between simple, gangrenous, and ruptured appendicitis in children.
- This biomarker may reduce reliance on CT scans, minimizing radiation exposure in pediatric appendicitis diagnosis.
Abstract:
Objectives: Appendicitis is a common abdominal emergency in children. It is difficult for clinicians to distinguish between simple appendicitis (SA), gangrenous appendicitis (GA), and ruptured appendicitis (RA) in children based on physical and current laboratory tests. Abdominal computed tomography with the disadvantage of excess radiation exposure is usually used in the emergency room for appendicitis surveys. Serum soluble CD40 ligand (sCD40L) is an inflammatory biomarker. This study aimed to use sCD40L to distinguish SA, GA, and RA. Methods: All patients aged <18 years old with suspected appendicitis were tested once for serum sCD40L within 72 h of appendicitis symptoms. We compared sCD40L levels of SA, GA, and RA individually on days 1, 2, and 3 in patients with normal appendix (NA), a total of nine subgroups. Thereafter, the diagnostic performance of sCD40L in predicting appendicitis and the receiver operating characteristic curves were carried out. Results: Of 116 patients, 42 patients had SA, 20 GA, 44 RA, and 10 NA. We found six subgroups with significant p-values of sCD40L predicting appendicitis as follows: SA on day 2, GA on days 2 and 3, and RA on days 1-3. The sensitivity and specificity of sCD40L at the best cutoff point with 178 pg/mL in these six subgroups range from 0.75 to 1.00 and 0.90, respectively. Conclusions: SCD40L is a good predictor of pediatric appendicitis. Clinicians can use sCD40L to distinguish from SA, GA, and RA in children with suspected appendicitis.
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