Abstract
BackgroundDiagnosis of acute appendicitis (AA) and decisions about its treatment remain among the most common dilemmas of pediatric surgical teams. Monitoring of immune response may be of importance for this purpose. Our aim was to measure and analyze serum and peritoneal fluid cytokines, in children who had undergone surgery for suspected AA.MethodsProspective investigation of serum and peritoneal fluid cytokine values was performed in 127 consecutive patients. According to the pathohistological findings, patients were divided into three groups: normal/early, uncomplicated and complicated AA. Determination of cytokine concentrations for 20 different cytokines was done using a commercial flow cytometry kit: Human Inflammation 20 plex BMS 819.ResultsStatistically significant differences in serum cytokine values between pathohistological groups were found for IP-10, MIP-1α and IL-10. Preoperative cut-off values of IP-10, MIP-1α and IL-10 between groups were obtained using ROC curve analysis. Positive correlations between serum and peritoneal concentrations were recorded for most of the analyzed cytokines.ConclusionIP-10, MIP-1α and IL-10 showed potential in assessment of AA in children. Confirmatory studies with a larger number of patients are required to prove reliability of these biomarkers.
Highlights
There is no clear guidance to drive a clinical decision between conservative and surgical treatment of acute appendicitis (AA) in children
Preoperative differences of serum cytokine values between pathohistological groups Statistically significant differences between preoperative serum cytokine values of the pathohistological groups were found for inducible protein 10 (IP-10), Macrophage inflammatory protein 1α (MIP-1α) and Interleukin 10 (IL-10) (Fig. 1)
The highest values of IP-10 were found in normal appendix or early stage appendicitis (NEAA), while the lowest were recorded in complicated appendicitis (CAA) group (Fig. 1 A)
Summary
There is no clear guidance to drive a clinical decision between conservative and surgical treatment of acute appendicitis (AA) in children. This results in significant number of unnecessary surgeries [1] or appendiceal perforations, classifying AA as one of the most frequently misdiagnosed conditions in pediatric surgery. Contributing factors include poor clinical history, insufficient cooperation during physical examination, and the medical team’s fear of perforative appendicitis risk [2]. Diagnosis of acute appendicitis (AA) and decisions about its treatment remain among the most common dilemmas of pediatric surgical teams. Monitoring of immune response may be of importance for this purpose. Our aim was to measure and analyze serum and peritoneal fluid cytokines, in children who had undergone surgery for suspected AA
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