Author:
Arredondo Montero Javier,Antona Giuseppa,Bronte Anaut Mónica,Bardají Pascual Carlos,Ros Briones Raquel,Fernández-Celis Amaya,Rivero Marcotegui Adriana,López-Andrés Natalia,Martín-Calvo Nerea
Abstract
Abstract
Introduction
Pediatric acute appendicitis (PAA) is a pathology with a high rate of diagnostic error. The search for new diagnostic tools is justified by the high morbidity and healthcare costs associated with diagnostic error.
Methods
We designed a prospective study to validate serum pentraxin-3 (PTX3) as a diagnostic tool in PAA. Participants were divided into three groups: (1) patients with no underlying pathology (2) patients with non-surgical abdominal pain and (3) patients with a confirmed diagnosis of PAA. For further analyses, patients in group 3 were divided into complicated or uncomplicated PAA. Quantitative variables were expressed as medians and interquartile ranges and categorical variables as percentages. Quantitative variables were compared using the Kruskal–Wallis test and the Mann–Whitney U test. Diagnostic performance was evaluated with ROC curves.
Results
This study included 215 patients divided into group 1 (n = 63), group 2 (n = 53) and group 3 (n = 99). Median serum PTX3 values were 2.54 (1.70–2.95) ng/mL, 3.29 (2.19–7.64) ng/mL and 8.94 (6.16–14.05) in groups 1, 2 and 3, respectively (p = 0.001). Patients with complicated PAA showed significantly higher values than patients with uncomplicated PAA (p = 0.04). The AUC (group 2 vs. 3) was 0.77 (95% CI 0.69–0.85) and the best cut-off point was at 7.28 ng/mL, with a sensitivity of 61.3% and a specificity of 73.1%. The AUC (complicated vs. uncomplicated PAA) was 0.65 (95% CI 0.54–0.77) and the best cut-off point was 12.33 ng/mL, with a sensitivity of 51.72% and a specificity of 72.73%.
Conclusions
The diagnostic ability of serum PTX3 in PAA is only moderate and therefore it cannot be considered a definitive diagnostic test. The discriminatory ability of PTX3 between complicated and uncomplicated PAA is poor. These findings, which contrast with those reported to date, should be validated with future properly designed prospective studies.
Publisher
Springer Science and Business Media LLC
Subject
General Medicine,Surgery,Pediatrics, Perinatology and Child Health
Reference22 articles.
1. Ingram MC, Harris CJ, Studer A, Martin S, Berman L, Alder A, Raval MV (2021) Distilling the key elements of pediatric appendicitis clinical practice guidelines. J Surg Res 258:105–112. https://doi.org/10.1016/j.jss.2020.08.056 (Epub 2020 Sep 30. PMID: 33010554; PMCID: PMC7736270)
2. Eun S, Ho IG, Bae GE, Kim H, Koo CM, Kim MK, Yoon SH (2021) Neutrophil-to-lymphocyte ratio for the diagnosis of pediatric acute appendicitis: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 25(22):7097–7107. https://doi.org/10.26355/eurrev_202111_27263 (PMID: 34859875)
3. Tuncer AA, Cavus S, Balcioglu A, Silay S, Demiralp I, Calkan E, Altin MA, Eryilmaz E, Karaisaoglu AO, Bukulmez A, Dogan I, Embleton DB, Cetinkursun S (2019) Can mean platelet volume, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, platelet-to-lymphocyte ratios be favourable predictors for the differential diagnosis of appendicitis? J Pak Med Assoc 69(5):647–654 (PMID: 31926114)
4. van Amstel P, Sarah-May ML, Bakx R, Bijlsma TS, Noordzij SM, Aajoud O, de Vries R, Derikx JPM, van Heurn LWE, Gorter RR (2022) Predictive scoring systems to differentiate between simple and complex appendicitis in children (PRE-APP study). Surgery. https://doi.org/10.1016/j.surg.2021.12.022 (Epub ahead of print. PMID: 35067338)
5. Fujii T, Tanaka A, Katami H, Shimono R (2021) Applying the Pediatric Appendicitis Score to predict complicated appendicitis in children. Pediatr Int 64(1):e14918. https://doi.org/10.1111/ped.14918 (Epub ahead of print. PMID: 34245633)
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