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Urinary biomarkers in pediatric appendicitis

Salö, Martin LU ; Roth, Bodil LU ; Stenström, Pernilla LU ; Arnbjörnsson, Einar LU and Ohlsson, Bodil LU (2016) In Pediatric Surgery International p.1-10
Abstract

Purpose: The diagnosis of pediatric appendicitis is still a challenge, resulting in perforation and negative appendectomies. The aim of this study was to evaluate novel biomarkers in urine and to use the most promising biomarkers in conjunction with the Pediatric Appendicitis Score (PAS), to see whether this could improve the accuracy of diagnosing appendicitis. Methods: A prospective study of children with suspected appendicitis was conducted with assessment of PAS, routine blood tests, and measurements of four novel urinary biomarkers: leucine-rich α-2-glycoprotein (LRG), calprotectin, interleukin 6 (IL-6), and substance P. The biomarkers were blindly determined with commercial ELISAs. Urine creatinine was used to adjust for... (More)

Purpose: The diagnosis of pediatric appendicitis is still a challenge, resulting in perforation and negative appendectomies. The aim of this study was to evaluate novel biomarkers in urine and to use the most promising biomarkers in conjunction with the Pediatric Appendicitis Score (PAS), to see whether this could improve the accuracy of diagnosing appendicitis. Methods: A prospective study of children with suspected appendicitis was conducted with assessment of PAS, routine blood tests, and measurements of four novel urinary biomarkers: leucine-rich α-2-glycoprotein (LRG), calprotectin, interleukin 6 (IL-6), and substance P. The biomarkers were blindly determined with commercial ELISAs. Urine creatinine was used to adjust for dehydration. The diagnosis of appendicitis was based on histopathological analysis. Results: Forty-four children with suspected appendicitis were included, of which twenty-two (50 %) had confirmed appendicitis. LRG in urine was elevated in children with appendicitis compared to children without (p <0.001), and was higher in children with gangrenous and perforated appendicitis compared to those with phlegmonous appendicitis (p = 0.003). No statistical significances between groups were found for calprotectin, IL-6 or substance P. LRG had a receiver operating characteristic area under the curve of 0.86 (95 % CI 0.79–0.99), and a better diagnostic performance than all routine blood tests. LRG in conjunction with PAS showed 95 % sensitivity, 90 % specificity, 91 % positive predictive value, and 95 % negative predictive value. Conclusion: LRG, adjusted for dehydration, is a promising novel urinary biomarker for appendicitis in children. LRG in combination with PAS has a high diagnostic performance.

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author
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Abdominal pain, Appendicitis, Biomarkers, Children
in
Pediatric Surgery International
pages
10 pages
publisher
Springer
external identifiers
  • Scopus:84976438404
ISSN
0179-0358
DOI
10.1007/s00383-016-3918-x
language
English
LU publication?
yes
id
81255965-3631-44ae-bd77-5e00eea3862c
date added to LUP
2016-07-21 11:21:50
date last changed
2016-11-08 15:05:34
@misc{81255965-3631-44ae-bd77-5e00eea3862c,
  abstract     = {<p>Purpose: The diagnosis of pediatric appendicitis is still a challenge, resulting in perforation and negative appendectomies. The aim of this study was to evaluate novel biomarkers in urine and to use the most promising biomarkers in conjunction with the Pediatric Appendicitis Score (PAS), to see whether this could improve the accuracy of diagnosing appendicitis. Methods: A prospective study of children with suspected appendicitis was conducted with assessment of PAS, routine blood tests, and measurements of four novel urinary biomarkers: leucine-rich α-2-glycoprotein (LRG), calprotectin, interleukin 6 (IL-6), and substance P. The biomarkers were blindly determined with commercial ELISAs. Urine creatinine was used to adjust for dehydration. The diagnosis of appendicitis was based on histopathological analysis. Results: Forty-four children with suspected appendicitis were included, of which twenty-two (50 %) had confirmed appendicitis. LRG in urine was elevated in children with appendicitis compared to children without (p &lt;0.001), and was higher in children with gangrenous and perforated appendicitis compared to those with phlegmonous appendicitis (p = 0.003). No statistical significances between groups were found for calprotectin, IL-6 or substance P. LRG had a receiver operating characteristic area under the curve of 0.86 (95 % CI 0.79–0.99), and a better diagnostic performance than all routine blood tests. LRG in conjunction with PAS showed 95 % sensitivity, 90 % specificity, 91 % positive predictive value, and 95 % negative predictive value. Conclusion: LRG, adjusted for dehydration, is a promising novel urinary biomarker for appendicitis in children. LRG in combination with PAS has a high diagnostic performance.</p>},
  author       = {Salö, Martin and Roth, Bodil and Stenström, Pernilla and Arnbjörnsson, Einar and Ohlsson, Bodil},
  issn         = {0179-0358},
  keyword      = {Abdominal pain,Appendicitis,Biomarkers,Children},
  language     = {eng},
  month        = {06},
  pages        = {1--10},
  publisher    = {ARRAY(0xc1fc170)},
  series       = {Pediatric Surgery International},
  title        = {Urinary biomarkers in pediatric appendicitis},
  url          = {http://dx.doi.org/10.1007/s00383-016-3918-x},
  year         = {2016},
}