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Differentiating familial Mediterranean fever attacks from acute appendicitis in children: which laboratory parameters

F Kalayci1, M Yigit1, E E Erten2

  • 1Department of Pediatrics, Ankara Bilkent City Hospital, Ankara, Turkey.

Scandinavian Journal of Rheumatology
|August 11, 2025
PubMed
Abstract

Insights

Inflammatory markers and delta neutrophil index (DNI) help differentiate familial Mediterranean fever (FMF) attacks from acute appendicitis (AA) in children. While DNI showed limited value, combined lab markers can aid diagnosis and management.

Area of Science:

  • Pediatric Gastroenterology
  • Pediatric Emergency Medicine
  • Clinical Immunology

Background:

  • Familial Mediterranean Fever (FMF) attacks and acute appendicitis (AA) present with overlapping symptoms in children, complicating diagnosis.
  • Accurate differentiation is crucial for timely and appropriate treatment, preventing complications.

Purpose of the Study:

  • To evaluate the diagnostic utility of inflammatory markers and the delta neutrophil index (DNI) in distinguishing FMF attacks from AA in pediatric patients.
  • To assess the combined diagnostic performance of various laboratory parameters.

Main Methods:

  • A retrospective analysis of 600 pediatric patients (200 FMF, 400 AA) diagnosed between 2019-2024.
  • Collected data included white blood cell count (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), platelet count (PLT), C-reactive protein (CRP), DNI, and neutrophil-to-lymphocyte ratio (NLR).
  • Statistical analysis included receiver operating characteristic (ROC) curve analysis and multivariate logistic regression.

Main Results:

  • The AA group showed significantly higher WBC, ANC, NLR, and DNI (p < 0.001).
  • The FMF group exhibited markedly elevated ALC and CRP (p < 0.001).
  • WBC, ANC, and NLR demonstrated high diagnostic performance; DNI had limited discriminatory value. Multivariate analysis identified increased DNI and ANC, and decreased CRP and PLT as significant predictors of AA (p < 0.001).

Conclusions:

  • Blood count parameters can support clinical examination and imaging in differentiating FMF attacks from AA in children.
  • Combined evaluation of multiple laboratory markers may expedite decision-making in pediatric patients.
  • Further research is needed to confirm the utility of these markers in routine clinical practice.

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