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Diagnostic performance of serum interleukin-6 in pediatric acute appendicitis: a systematic review
Javier Arredondo Montero1, Carlos Bardají Pascual2, Mónica Bronte Anaut3
1Pediatric Surgery Department, Complejo Hospitalario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain. Javier.montero.arredondo@gmail.com.
Insights
Serum interleukin-6 shows limited diagnostic ability for pediatric appendicitis alone. Its performance is moderate for uncomplicated cases but improves for complicated appendicitis, suggesting potential for future research.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
- Biomarker Research
Background:
- Diagnostic errors persist in pediatric acute appendicitis despite technological advancements.
- Serum biomarkers are increasingly explored as diagnostic aids.
- The utility of serum interleukin-6 (IL-6) in diagnosing pediatric appendicitis requires further investigation.
Purpose of the Study:
- To systematically review and analyze the diagnostic performance of serum interleukin-6 (IL-6) in pediatric acute appendicitis.
Main Methods:
- A systematic literature review was conducted across major medical databases (Medline, PubMed, Web of Science, SciELO).
- Two independent reviewers selected studies based on predefined criteria, assessed methodological quality using QUADAS-2, and extracted data.
- Nine studies met the inclusion criteria, with eight providing IL-6 measurements.
Main Results:
- While all included studies reported significant differences in IL-6 levels between groups, results for sensitivity and specificity were inconsistent.
- Serum IL-6 demonstrated moderate sensitivity and specificity for non-complicated pediatric appendicitis.
- Sensitivity and specificity increased for complicated appendicitis.
Conclusions:
- Serum interleukin-6 (IL-6) alone has limited diagnostic value for pediatric acute appendicitis.
- IL-6 levels correlate with the duration of abdominal pain in pediatric appendicitis.
- Further research into IL-6's potential to differentiate complicated from uncomplicated appendicitis is warranted, especially with the rise of non-operative management.
Background:
Despite the radiological and analytical advances of the last decades, there is still a significant rate of diagnostic error in pediatric acute appendicitis. In recent years, multiple biomarkers have emerged as potential diagnostic tools. This study aimed to examine the diagnostic performance of serum interleukin-6 in pediatric acute appendicitis.
Methods:
We conducted a systematic review of the literature that involved an extensive search in the main databases of medical bibliography (Medline, PubMed, Web of Science and SciELO). Two independent reviewers selected the relevant articles based on the previously defined inclusion and exclusion criteria. Methodological quality of the selected article was rated using the QUADAS2 index. Data extraction was performed by two independent reviewers.
Results:
The research in the medical bibliography databases resulted in 68 articles. We removed 26 duplicates. Among the remaining 42 articles, we excluded 33 following the inclusion and exclusion criteria. Of the final 9 studies included in this review, 8 provided measured serum interleukin-6 values, and all of them reported significant differences between groups, but inconsistent results regarding sensitivity and specificity.
Conclusions:
The diagnostic performance of interleukine-6 alone for the diagnosis of acute appendicitis in children is limited. The sensitivity and specificity of interleukine-6 for the diagnosis of non-complicated acute appendicitis in the pediatric population are moderate but increased in complicated appendicitis. There seems to be a direct relationship between serum level of interleukin-6 and the hours of evolution of abdominal pain in children with acute appendicitis. The increasingly widespread use of non-operative management of acute appendicitis warrants further exploration of the classificatory potential of this marker between complicated and uncomplicated appendicitis. We consider that this may be an avenue of research to explore in the future.
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