Abstract
BackgroundAcute appendicitis (AA) is a common surgical problem that is associated with an acute-phase reaction. Previous studies have shown that cytokines and acute-phase proteins are activated and may serve as indicators for the severity of appendicitis. The aim of this study was to compare diagnostic value of different serum inflammatory markers in detection of phlegmonous or perforated appendicitis in children.MethodsData were collected prospectively on 211 consecutive children. Laparotomy was performed for suspected AA for 189 patients. Patients were subdivided into groups: nonsurgical abdominal pain, early appendicitis, phlegmonous or gangrenous appendicitis, perforated appendicitis.White blood cell count (WBC), serum C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), acid α1-glycoprotein (α1GP), endotoxin, and erythrocyte sedimentation reaction (ESR) were estimated ad the time of admission. The diagnostic performance was analyzed using receiver operating characteristic (ROC) curves.ResultsWBC count, CRP and IL-6 correlated significantly with the severity of appendiceal inflammation. Identification of children with severe appendicitis was supported by IL-6 or CRP but not WBC. Between IL-6 and CRP, there were no significant differences in diagnostic use.ConclusionLaboratory results should be considered to be integrated within the clinical assessment. If used critically, CRP and IL-6 equally provide surgeons with complementary information in discerning the necessity for urgent operation.
Highlights
Acute appendicitis (AA) is a common surgical problem that is associated with an acute-phase reaction
For the patients included in this study, White blood cell count (WBC) count, platelets, erythrocyte sedimentation reaction (ESR), C-reactive protein (CRP), IL-6, tumor necrosis factor α (TNF-α), α1-GP, and endotoxin were found as presented in table 3
Further analysis was restricted to CRP, IL-6 and WBC count
Summary
Acute appendicitis (AA) is a common surgical problem that is associated with an acute-phase reaction. The aim of this study was to compare diagnostic value of different serum inflammatory markers in detection of phlegmonous or perforated appendicitis in children. On the other hand in young children, geriatric patients, and in adolescent females, the negative appendectomy rate may be as high as 50 % [2]. Many attempts have been made to determine ways of decreasing the negative laparotomy rate after a clinical suspicion of AA. Under this background it would be very important to differentiate mild early appendicitis from nonspecific abdominal pain. The diagnostic value of laboratory inflammatory markers has been studied in the past years with different and contradictory results, commonly in a heterogeneous population of adults and children [4]
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