Abstract
BackgroundRecently, several serum and urinary biomarkers have been investigated for diagnosis of acute appendicitis. Urinary biomarkers seem to be advantageous in children as it is non-invasive, painless, and easy to perform. Leucine-rich α-2-glycoprotein (LRG) is regarded as a reliable urinary biomarker for the diagnosis of pediatric appendicitis. A prospective observational pilot study was conducted in children presenting with abdominal pain. Assessment of pediatric appendicitis score (PAS), routine blood tests, and measurements of urinary LRG was done. The present study aimed to evaluate the diagnostic accuracy of urine LRG in appendicitis in Indian children and to assess the concentration of urine LRG at which it will guide the management.ResultsLRG had a receiver operating characteristic (ROC) area under the curve (AUC) of 0.586 (95% CI 0.407–0.766). There was no specific cut-off identified using Youden’s index. ROC analysis of the PAS score resulted in an AUC of 0.821 (95% CI 0.691–0.952). Using Youden’s index, the cut-off for PAS scoring was identified as 6.5 with the sensitivity of 80%, the specificity of 76.2%, positive predictive value 76.19%, negative predictive value as 80%, and diagnostic accuracy of 78%.ConclusionsLRG could not show better diagnostic performance compared to routine blood tests and PAS scores. There was no specific cut-off value at which it will differentiate mesenteric adenitis and acute appendicitis and guide their management. With 78% diagnostic accuracy, PAS score (> 6) is still a better tool for the diagnosis of acute appendicitis.Trial registrationClinical Trials Registry Government of India, CTRI/2018/01/011182, Registered on: 08 Jan 2018.
Highlights
Several serum and urinary biomarkers have been investigated for diagnosis of acute appendicitis
The study aimed to evaluate the diagnostic accuracy of urine Leucine-rich α-2-glycoprotein (LRG) in pediatric appendicitis and whether it can differentiate between appendicitis and mesenteric lymphadenitis
A prospective observational pilot study was designed to validate the diagnostic accuracy of urine LRG in an independent cohort of pediatric and adolescent patients presenting to the outpatient department (OPD) and emergency department (ED) with abdominal pain mimicking acute appendicitis at our tertiary teaching hospital
Summary
Several serum and urinary biomarkers have been investigated for diagnosis of acute appendicitis. Leucine-rich α-2-glycoprotein (LRG) is regarded as a reliable urinary biomarker for the diagnosis of pediatric appendicitis. Assessment of pediatric appendicitis score (PAS), routine blood tests, and measurements of urinary LRG was done. Accurate clinical diagnosis of pediatric appendicitis remains a challenge and a perfect test is yet to be found. Mesenteric lymphadenitis is an important differential diagnosis in children as it clinically mimics appendicitis. Even with PAS score ≥ 8, there is a 5% rate of negative appendectomy [3]. Advanced imaging studies such as ultrasonography (US) and computed tomography (CT) are often used to confirm or rule out appendicitis. CT scans in children should be avoided whenever possible
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