Abstract
Background Several efforts have been made to find out a valuable marker to assist the diagnosis and differentiation of gangrenous/perforated appendicitis. We aimed to determine the diagnostic capacity of soluble B7H3 (sB7H3) in acute appendicitis (AA) and its accuracy as a predictor of the severity of appendicitis. Methods 182 children were allocated into four groups as follows: control group (CG, 90), simple appendicitis (SA, 12), purulent appendicitis (PA, 49), and gangrenous appendicitis (GA, 31). Prior to appendectomy, blood was collected and sent for analysis of routine examination and cytokines (sB7H3 and TNF-α). We compared values of all measured parameters according to histological findings. Furthermore, we assigned AA patients into the nonperforated appendicitis group and the perforated appendicitis group. The diagnostic effects of significant markers were assessed by ROC curves. Results Only the levels of CRP, FIB, and sB7H3 had a remarkable rising trend in AA-based groups, while differences in the levels of CRP and FIB between simple appendicitis and purulent appendicitis were not statistically significant. In addition, sB7H3 was found as the only marker in children with AA, which was markedly associated with the degree of histological findings of the appendix. Furthermore, sB7H3 had a high diagnostic value in predicting AA and complex appendicitis (PA+GA) in children. However, the diagnostic performance of sB7H3 for distinguishing PA from GA was not remarkable. Additionally, only the levels of CRP and sB7H3 were statistically different between the nonperforated appendicitis group and the perforated appendicitis group. The diagnostic performance of CRP and sB7H3 could not merely predict perforation of AA in children; however, the diagnostic performance was improved after combination. Conclusions sB7H3 could be used as a valuable marker to predict the presence of AA and complex AA in children. However, the diagnostic value of sB7H3 to predict gangrenous/perforated appendicitis was not found to be remarkable. The combination of sB7H3 and CRP might improve the prediction of perforated appendicitis.
Highlights
Acute abdominal pain is one of the frequent chief complaints of children; acute appendicitis (AA) is the most common surgical emergency in the pediatric population [1]
There was no difference in gender between the control group (CG) and the AA group (P > 0:05); the age of the AA group was slightly older than that of the CG (P < 0:05), but there was no significant difference in age between the CG and the AA-based group (P > 0:05)
The findings showed that soluble B7H3 (sB7H3) had a high diagnostic accuracy for complex AA (PA+gangrenous appendicitis (GA))
Summary
Acute abdominal pain is one of the frequent chief complaints of children; acute appendicitis (AA) is the most common surgical emergency in the pediatric population [1]. The perforation of the inflamed appendix may result in peritonitis or intraabdominal abscess formation. SB7H3 was found as the only marker in children with AA, which was markedly associated with the degree of histological findings of the appendix. SB7H3 had a high diagnostic value in predicting AA and complex appendicitis (PA+GA) in children. Only the levels of CRP and sB7H3 were statistically different between the nonperforated appendicitis group and the perforated appendicitis group. The diagnostic performance of CRP and sB7H3 could not merely predict perforation of AA in children; the diagnostic performance was improved after combination. The diagnostic value of sB7H3 to predict gangrenous/perforated appendicitis was not found to be remarkable. The combination of sB7H3 and CRP might improve the prediction of perforated appendicitis
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