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Blood biomarkers to distinguish complicated and uncomplicated appendicitis in pediatric patients
Siu Chung Ha1, Ya-Hui Tsai2, Chee-Chee Koh3
1Department of Surgery, Far Eastern Memorial Hospital, Pan-Chiao, New Taipei, 220, Taiwan; Department of Chemical Engineering and Materials Science, Yuan Ze University, Chung-Li, Taoyuan 320, Taiwan.
Insights
C-reactive protein (CRP) effectively distinguishes complicated appendicitis from uncomplicated appendicitis in children. This blood biomarker aids in early diagnosis and management of acute appendicitis, improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Diagnostic Biomarkers
- Inflammatory Markers
Background:
- Acute appendicitis is a common cause of pediatric abdominal pain.
- Distinguishing complicated appendicitis (CA) from uncomplicated appendicitis (UA) is crucial for patient management.
- Early and accurate diagnosis of appendicitis is essential to prevent increased morbidity.
Purpose of the Study:
- To evaluate the diagnostic utility of blood biomarkers in differentiating CA from UA in pediatric patients.
- To identify specific inflammatory markers that can predict the progression of appendicitis.
Main Methods:
- Retrospective review of 192 pediatric patients with appendicitis.
- Categorization into UA and CA groups based on histopathology.
- Analysis of white blood cell count, neutrophil and lymphocyte proportions, NLR, MLR, PLR, and CRP levels.
Main Results:
- Patients with CA showed higher neutrophil proportions, NLR, PLR, and CRP levels compared to UA patients.
- Lower lymphocyte proportions were observed in the CA group.
- C-reactive protein (CRP) demonstrated the highest specificity, sensitivity, and predictive values for CA detection via ROC analysis.
Conclusions:
- C-reactive protein (CRP) is a valuable biomarker for differentiating complicated appendicitis from uncomplicated appendicitis in pediatric cases.
- CRP aids in the early identification of severe appendicitis, guiding timely surgical intervention.
Background/Purpose:
Acute appendicitis (AA) stands as the most prevalent cause of acute abdominal pain among children. The potential for morbidity escalates significantly when uncomplicated appendicitis (UA) progresses to complicated appendicitis (CA), which can encompass gangrenous, necrotic, or perforated appendicitis. Consequently, establishing an early and accurate diagnosis of AA, and effectively differentiating CA from UA, becomes paramount. This study explores the diagnostic utility of various blood biomarkers for distinguishing CA from UA in pediatric patients.
Methods:
We conducted a retrospective review of medical records pertaining to pediatric patients who underwent surgery for AA. Patients were categorized as either having UA or CA based on histopathological examination of the appendix. The data collected and analyzed included demographic information, white blood cell (WBC) count, neutrophil proportion, lymphocyte proportion, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) levels upon admission.
Results:
Among the 192 pediatric patients who underwent surgery for AA, 150 were diagnosed with UA, while 42 were diagnosed with CA. The CA group exhibited significantly higher neutrophil proportions, NLRs, PLRs, and CRP levels, alongside lower lymphocyte proportions (all p < 0.01) compared to the UA group. Receiver operating characteristic (ROC) curve analysis disclosed that CRP exhibited the highest specificity, sensitivity, and positive and negative predictive values for predicting CA.
Conclusion:
CRP emerges as a valuable biomarker for differentiating complicated appendicitis from uncomplicated appendicitis.
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