Abstract
ObjectiveAppendicitis is very commonly encountered in emergency clinics. There is an urgent need for early and accurate predictive biomarkers of appendicitis in order to save lives, because currently-available biomarkers are imprecise and their delayed response impairs the ability of emergency doctors and pediatric surgeons to provide timely and potentially effective therapies. This study was performed to determine whether changes in the blood levels of neutrophil gelatinase-associated lipocalin (NGAL) can help to diagnose acute appendicitis in children and distinguish acute appendicitis from abdominal pain.MethodsSixty children were enrolled and divided into three groups, with 20 patients per group: Group 1 (patients with appendicitis), Group 2 (patients with abdominal pain) and Group 3 (control). Blood NGAL levels were determined by ELISA.ResultsThe basal average serum NGAL levels were 8.2 ng/ml for Group 1, 3.9 ng/ml for Group 2, and 3.3 ng/ml for Group 3. Twenty-four and 72 h after surgery the levels were 5.1 and 2.8 ng/ml, respectively, in Group 1, 2.9 and 2.8 ng/ml in Group 2, and 2.6, 2.7 ng/ml in Group 3. Setting the cut-off point to 7 generated an area under the receiving operating curve (ROC) curve at 95 % confidence interval with 77.3 % sensitivity and 97.4 % specificity.ConclusionThese data indicate a significant difference in NGAL values between basal and postoperative measurements in appendicitis patients (p < 0.05). The ROC curve results showed that NGAL is a promising novel biomarker for the differential diagnosis of acute appendicitis from abdominal pain.
Highlights
Appendectomy is the most commonly-performed emergency operation in pediatric surgery clinics
The clinical signs of appendicitis arise from an inflammatory process that begins as a luminal obstruction and proceeds to abdominal pain
When the Alvarado scores were compared with the serum neutrophil gelatinase-associated lipocalin (NGAL) levels, we found that setting the cutoff point to 7 resulted in an area under the receiving operating curve (ROC) curve
Summary
Appendectomy is the most commonly-performed emergency operation in pediatric surgery clinics. The clinical signs of appendicitis arise from an inflammatory process that begins as a luminal obstruction and proceeds to abdominal pain. Diagnosis is based on clinical findings and there is still no definitive laboratory diagnosis. Clinical signs of appendicitis can be confused with many diseases associated with abdominal pain (Alvarado 1986; Apak et al 2005; Brănescu et al 2012; Nance et al 2000; Rodriguez-Sanjuan et al 1999). The Alvarado scoring system is used in the diagnosis of acute appendicitis and is calculated out of a total of 10 points on the basis of symptoms, clinical findings, leukocyte count and radiological findings. Observation and/or additional definite laboratory evaluation are needed for scores of 5–6 (Alvarado 1986). Clinicians still encounter problems such as perforation, negative appendectomy, mortality, morbidity, and long hospital stays
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