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Diagnostic performance of urinary 5-Hydroxyindoleacetic Acid in acute appendicitis: a systematic review and diagnostic test accuracy meta-analysis

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Abstract

Objectives

This study aimed to analyze the diagnostic performance of urinary 5-Hydroxyindoleacetic Acid (5-HIAA) in acute appendicitis (AA).

Methods

This review was registered in PROSPERO (CRD42023399541). We included prospective or retrospective original clinical studies evaluating the diagnostic performance of 5-HIAA in AA. A search was conducted in PubMed, Web of Science, Scopus and OVID. Search terms and keywords were: (appendicitis OR acute appendicitis) AND (5-HIAA OR 5-Hydroxyindoleacetic acid OR serotonin metabolite). Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS2 index. A synthesis of the results, standardization of the metrics, and a random-effect meta-analysis were performed. Additionally, a coupled forest plot and a diagnostic test accuracy meta-analysis (DTA) were performed.

Results

Twelve studies with data from 1467 participants (724 patients with a confirmed diagnosis of AA and 743 controls) were included in this review. The random-effect meta-analysis of urinary 5-HIAA (AA vs controls) included 7 articles (352 AA and 258 controls) and resulted in a significant mean difference [95% CI] of 23.30 [15.82–30.77] μmol/L (p < 0.001). The DTA meta-analysis of urinary 5-HIAA included 8 articles and resulted in a pooled sensitivity [95% CI] of 68.6 [44.1–85.9]% and a pooled specificity [95% CI] of 82 [54.7–94.5]%.

Conclusions

Although the evidence is heterogeneous and limited, urinary 5-HIAA emerges as a potential non-invasive diagnostic tool for AA. Urinary 5-HIAA does not seem to be a useful biomarker to distinguish between NCAA and CAA. Future prospective studies with a large sample size and a rigorous design are necessary to validate these findings.

Trial registration: PROSPERO (CRD42023399541)

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Data availability

The data used to carry out this systematic review are available upon request from the review authors.

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Funding

This review did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. None of the authors have external funding to declare.

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Authors and Affiliations

  1. Pediatric Surgery Department, Complejo Asistencial Universitario de León, C/Altos de Nava S/N, 24008, León, Castilla y León, Spain

    Javier Arredondo Montero

  2. School of Medicine, University of Navarra, Pamplona, Navarra, Spain

    Javier Arredondo Montero, Oscar Emilio Bueso Asfura, Blanca Paola Pérez Riveros, Emilio López Burgos & María Rico Jiménez

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  1. Javier Arredondo Montero
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Contributions

Javier Arredondo Montero: Conceptualization and study design; literature search and selection, data curation and extraction, formal analysis; investigation; methodology; project administration; resources; validation; visualization; writing – original draft; writing – review and editing. Oscar Emilio Bueso Asfura, Blanca Paola Pérez-Riveros, Emilio López Burgos, María Rico Jiménez: literature search and selection, data curation and extraction.

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Correspondence to Javier Arredondo Montero.

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Arredondo Montero, J., Bueso Asfura, O.E., Pérez Riveros, B.P. et al. Diagnostic performance of urinary 5-Hydroxyindoleacetic Acid in acute appendicitis: a systematic review and diagnostic test accuracy meta-analysis. Int J Colorectal Dis 38, 269 (2023). https://doi.org/10.1007/s00384-023-04556-w

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