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Determining acute complicated and uncomplicated appendicitis using serum and urine biomarkers: interleukin-6 and neutrophil gelatinase-associated lipocalin

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Abstract

Purpose

The study aim is to determine whether serum and urine interleukin-6 (IL-6) and neutrophil gelatinase-associated lipocalin (NGAL) can be included in the early diagnostic algorithm for pediatric appendicitis.

Methods

Prospective single-center cohort study included 92 children divided into control, acute complicated appendicitis (AcA) and acute uncomplicated appendicitis (AnA) groups. Serum and urine samples were assayed for IL-6 and NGAL preoperatively, and on the second and fifth postoperative days. Intraoperative and bacteriological findings divided the appendicitis patients.

Results

Average serum biomarker levels were higher in appendicitis patients versus the control, and the following values were produced via receiver operating characteristic (ROC) analysis. NGAL and IL-6 cutoff values were 113.95 ng/ml and 24.64 pg/ml, respectively, NGAL had 68.3% sensitivity and 65.5% specificity, while IL-6 had 72.6% and 86.2%. Comparing AcA and AnA, IL-6 was the only biomarker of significance yielding 77.4% sensitivity and 58.1% specificity with a 26.43 pg/ml cutoff value. Urine biomarkers were non-specific in differentiation appendicitis severity and ultimately, between infectious and non-infectious disease.

Conclusion

Although NGAL provided measurable useful diagnostic information in evaluating children for appendicitis, its values were not sufficient for appendicitis severity. Serum IL-6 remains a strong biomarker for suspected acute appendicitis and has promising results predicting its severity.

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Acknowledgements

The authors would like to acknowledge every single person, the Ethics Committee, the Latvian Council of Science, and Riga Stradins University, for their sincere contribution in funding this project.

Funding

This study was funded by Latvian Academy of Science and Riga Stradins University.

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Authors and Affiliations

  1. Department of Biology and Microbiology, Riga Stradins University, Dzirciema iela, 16, Riga, 1007, Latvia

    Renars Broks, Aigars Reinis & Juta Kroica

  2. Department of Pediatric Surgery, Children’s Clinical University Hospital, Vienibas gatve, 45, Riga, 1004, Latvia

    Mohit Kakar, Marisa Butnere, Arnis Engelis & Aigars Petersons

  3. Department of Pediatric Surgery, Imperial College London, Chelsea Children’s Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK

    Amulya Saxena

  4. Department of Pediatric Surgery, Riga Stradins University, Dzirciema iela, 16, Riga, Latvia

    Mohit Kakar, Marisa Butnere, Arnis Engelis & Aigars Petersons

  5. Faculty of Medicine, Riga Stradins University, Dzirciema iela, 16, Riga, Latvia

    Mathilde Delorme

  6. Department of Statistics, Riga Stradins University, Dzirciema iela, 16, Riga, Latvia

    Lasma Asare

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  1. Mohit Kakar
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Correspondence to Mohit Kakar.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Riga Stradins University; reference number: 21/27.04.2017. and Children’s Clinical University Hospital; reference number: SP-37/2018.) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from a parent of each individual participant included in the study.

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Kakar, M., Delorme, M., Broks, R. et al. Determining acute complicated and uncomplicated appendicitis using serum and urine biomarkers: interleukin-6 and neutrophil gelatinase-associated lipocalin. Pediatr Surg Int 36, 629–636 (2020). https://doi.org/10.1007/s00383-020-04650-y

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  • DOI: https://doi.org/10.1007/s00383-020-04650-y

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