Perioperative changes in IgG and plasma N-glycosylation in children with acute appendicitis and elective surgery: a...

To compare plasma protein and IgG N-glycosylation levels in pediatric patients undergoing acute appendicitis surgery and in those undergoing minor elective surgery. The secondary aim was to explore whether the plasma N-glycome profile may serve as a biomarker of systemic inflammatory burden in children.

This prospective study enrolled children aged 4-16 years undergoing minor elective surgery (n = 38) or surgery for acute appendicitis (n = 19) at Children's Hospital Zagreb from 2017 to 2021. Blood samples were collected preoperatively and 24 hours postoperatively. IgG and total plasma N-glycans were assessed using high-throughput hydrophilic interaction ultra-high-performance liquid chromatography. Derived glycan traits were compared between the groups and across timepoints.

Compared with elective surgery controls, children with acute appendicitis exhibited extensive plasma glycomic remodeling. This was characterized by increased branching, sialylation, and antennary fucosylation, along with reduced abundance of less complex glycans, indicating a systemic inflammatory glycan phenotype. IgG glycosylation also differed between the groups but showed fewer and less pronounced changes. Minor elective surgery, despite increased C-reactive protein levels, did not significantly alter either plasma or IgG glycomes. Twenty-four hours after surgery, children with appendicitis exhibited significant postoperative changes only in the plasma N-glycome, while IgG glycosylation remained stable.

Plasma N-glycosylation reflects inflammatory burden rather than surgical stress. These findings highlight plasma glycome profiling as a potential systems-level biomarker for assessing acute inflammation and disease severity in pediatric populations.