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Urinary biomarkers in pediatric appendicitis

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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 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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Acknowledgments

The study was financed by Grants from the Development Foundation of Region Skåne and Magtarmfonden.

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Authors and Affiliations

  1. Department of Clinical Sciences, Lund University, Lund, Sweden

    Martin Salö, Pernilla Stenström & Einar Arnbjörnsson

  2. Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, 221 85, Lund, Sweden

    Martin Salö, Pernilla Stenström & Einar Arnbjörnsson

  3. Division of Internal Medicine, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, 205 02, Lund, Sweden

    Bodil Roth & Bodil Ohlsson

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  1. Martin Salö
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Correspondence to Martin Salö.

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Salö, M., Roth, B., Stenström, P. et al. Urinary biomarkers in pediatric appendicitis. Pediatr Surg Int 32, 795–804 (2016). https://doi.org/10.1007/s00383-016-3918-x

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