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Hyperfibrinogenemia and hyponatremia as predictors of perforated appendicitis in children: A retrospective cohort
Zhenfei Wu1, Lingling Zhao2, Shaoguang Feng1
1Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China.
Insights
Hyponatremia and hyperfibrinogenemia are effective indicators for identifying perforated appendicitis in children. Combining these markers offers the best predictive value for appendix perforation, aiding treatment decisions.
Area of Science:
- Pediatric Surgery
- Biochemistry
- Diagnostic Markers
Background:
- Appendicitis is a common surgical emergency in children.
- Perforated appendicitis increases morbidity and requires prompt diagnosis.
- Identifying reliable predictive markers for perforation is crucial for timely intervention.
Purpose of the Study:
- To evaluate the predictive accuracy of hyperfibrinogenemia and hyponatremia for perforated appendicitis in pediatric patients.
- To compare the diagnostic performance of individual markers versus their combination.
Main Methods:
- Retrospective analysis of 521 pediatric patients with histopathologically confirmed appendicitis.
- Division into non-perforated (73%) and perforated (27%) groups.
- Analysis of pre-operative serum sodium and fibrinogen levels using ROC curve analysis.
Main Results:
- Hyperfibrinogenemia (≥4.0 g/L) and hyponatremia (≤135 mmol/L) were more prevalent in the perforated appendicitis group.
- The combination of hyponatremia and hyperfibrinogenemia demonstrated the highest area under the ROC curve (0.858) for predicting perforation.
- Combined markers showed superior positive and negative predictive values compared to individual markers.
Conclusions:
- Hyponatremia and hyperfibrinogenemia serve as valuable predictive markers for perforated appendicitis in children.
- Utilizing these biochemical markers can supplement clinical decisions regarding surgical timing and non-operative management.
- Further research can validate these findings for routine clinical application.
Purpose:
The aim of this study was to investigate the predictive value of hyperfibrinogenemia and hyponatremia for perforated appendicitis in children.
Methods:
A retrospective review of 521 pediatric patients (≤ 15 years) with acute appendicitis confirmed by histopathology from January 2017 to December 2020 was performed. Patients were divided in two groups, those with non-perforated (n = 379; 73%) and perforated appendicitis (n = 142; 27%). The serum values of sodium and fibrinogen were taken before surgery. We performed the receiver operating characteristic analysis for the two biochemical markers. The sensitivity, specificity, positive and negative predictive values for perforated appendicitis in the presence of hyponatremia and hyperfibrinogenemia were calculated.
Results:
Hyperfibrinogenemia (≥ 4.0 g/L) was found in 58.45% of perforated appendicitis and 104 of 142 (73.34%) children with perforated appendicitis had hyponatremia (≤ 135 mmol/L). The perforated appendicitis group had a higher mean fibrinogen concentration (P = 0.001). There was a statistically significant difference in mean serum sodium levels between the perforated appendicitis and non-perforated appendicitis groups (P = 0.016). Receiver operating characteristic curve analysis for fibrinogen, sodium and combination of the both markers shown the combination had the largest area under the curve in identifying children with perforated acute appendicitis (0.858) (95% CI, 0.82-0.90) compared with fibrinogen (0.815) (95% CI, 0.77-0.86) and sodium 0.818 (95% CI, 0.78-0.86) alone. Furthermore, the combination of both markers had the best positive and negative predictive value for appendix perforation compared to fibrinogen and sodium.
Conclusion:
Hyponatremia and/or hyperfibrinogenemia are excellent markers for predicting perforated appendicitis in children. We propose that plasma sodium and/or fibrinogen concentrations be utilized as a supplementary to guide individual treatment decisions in children with appendicitis, such as surgery timing and nonoperative management options.
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