Can common serum biomarkers predict complicated appendicitis in children?

Autor: Zani A; Division of General and Thoracic Surgery, The Hospital for Sick Children, 1524C-555 University Ave, Toronto, ON, M5G 1X8, Canada. augusto.zani@sickkids.ca., Teague WJ; Paediatric Surgery, Royal Children's Hospital, Melbourne, Australia., Clarke SA; Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK., Haddad MJ; Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK., Khurana S; Paediatric Surgery, Adelaide Women's and Children's Hospital, Adelaide, Australia., Tsang T; Paediatric Surgery, Norfolk and Norwich University Hospital, Norwich, UK., Nataraja RM; Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia.; Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Jazyk: angličtina
Zdroj: Pediatric surgery international [Pediatr Surg Int] 2017 Jul; Vol. 33 (7), pp. 799-805. Date of Electronic Publication: 2017 Apr 29.
DOI: 10.1007/s00383-017-4088-1
Abstrakt: Purpose: As appendicitis in children can be managed differently according to the severity of the disease, we investigated whether commonly used serum biomarkers on admission could distinguish between simple and complicated appendicitis.
Methods: Admission white blood cell (WBC), neutrophil (NEU), and C-reactive protein (CRP) levels were analysed by ROC curve, and Kruskal-Wallis and contingency tests. Patients were divided according to age and histology [normal appendix (NA), simple appendicitis (SA), complicated appendicitis (CA)].
Results: Of 1197 children (NA = 186, SA = 685, CA = 326), 7% were <5 years, 55% 5-12, 38% 13-17. CA patients had higher CRP and WBC levels than NA and SA (p < 0.0001). NEU levels were lower in NA compared to SA or CA (p < 0.0001), but were similar between SA and CA (p = 0.6). CA patients had higher CRP and WBC levels than SA patients in 5-12- (p < 0.0001) and 13-17-year groups (p = 0.0075, p = 0.005), but not in <5-year group (p = 0.72, p = 0.81). We found CRP >40 mg/L in 58% CA and 37% SA (p < 0.0001), and WBC >15 × 10 9 /L in 58% CA and 43% SA (p < 0.0001).
Conclusions: Admission CRP and WBC levels may help the clinician predict complicated appendicitis in children older than 5 years of age. Early distinction of appendicitis severity using these tests may guide caregivers in the preoperative decision-making process.
Databáze: MEDLINE
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