A novel noninvasive appendicitis score with a urine biomarker

Abstract

Purpose: The aim of our study was to develop an appendicitis score incorporating a urine biomarker, Leucine rich alpha-2-glycoprotein (LRG), for evaluation of children with abdominal pain. Methods: From January to August 2017 we prospectively enrolled children aged 4-16 years old admitted for suspected appendicitis. Urine samples for LRG analysis were obtained preoperatively and quantified by enzyme-linked immunosorbent assay (ELISA) after correction for patient hydration status. The diagnosis of appendicitis was based on operative findings and histology. Logistic regression was used to identify prospective predictors.Results: A total of 148 patients were recruited, of which 42(28.4%) were confirmed appendicitis. Our Appendicitis Urinary Biomarker (AuB) model incorporated urine LRG with 3 clinical predictors: 'constant pain', 'right iliac fossa tenderness', 'pain on percussion'. Area under the ROC curve for AuB was 0.82 versus 0.78 for the Pediatric Appendicitis Score (PAS) on the same cohort of patients. A model-calculated risk score of b 0.15 is interpreted as low risk of appendicitis. Sensitivity for the AuB at this cutoff was 97.6%, specificity 37.7%, negative predictive value 97.6%, positive predictive value 38.3%, and negative likelihood ratio 0.06. Conclusion: The noninvasive AuB score appears promising as a diagnostic tool for excluding appendicitis in children without the need for blood sampling. Type of study: Study of diagnostic test. Level of evidence: Level III.

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

“…Among the new laboratory biomarkers developed, the Appendicitis Urinary Biomarker (AuB—leucine-rich alpha-2-glycoprotein) appears promising as a diagnostic tool for excluding AA in children, without the need for blood sampling (negative predictive value 97.6%) [ 63 ].…”

“…Among the new laboratory biomarkers developed, the Appendicitis Urinary Biomarker (AuB-leucine-rich alpha-2-glycoprotein) appears promising as a diagnostic tool for excluding AA in children, without the need for blood sampling (negative predictive value 97.6%) [63]. Statement 1.7 White blood cell count, the differential with the calculation of the absolute neutrophil count, and the CRP are useful lab tests in predicting acute appendicitis in children; moreover, CRP level on admission ≥ 10 mg/L and leucocytosis ≥ 16,000/mL are strong predictive factors for appendicitis in pediatric patients.…”

Serum and Urine Biomarker Leucine-Rich Alpha-2 Glycoprotein 1 Differentiates Pediatric Acute Complicated and Uncomplicated Appendicitis

“…Multiple recent publications demonstrate the correlation between an enriched s-LRG1 concentration and the confirmed diagnosis of AA in children, which also is supported by this study’s findings [ 7 , 12 , 13 , 14 , 17 , 18 , 19 ]. A vast amount of clinical reports observes increased s-LRG1 levels in the development of a variety of disorders such as inflammatory disorders (intestinal, renal, and respiratory systems), oncological pathology (e.g., colorectal cancer, hepatocellular carcinoma, pancreatic cancer, ovarian cancer, lung cancer) and other chronic conditions (e.g., ulcerative colitis (UC), hydrocephalus, heart failure) [ 15 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. The presence of LRG1 in diseased appendices and serum can be explained by neutrophils secreting LRG1 in response to bacteria [ 12 , 14 , 19 , 25 , 30 ].…”

Analysis of the results of using the Pediatric Appendicitis Score in the differential diagnosis of abdominal pain in children aged 5–17 years

“…Клиническая диагностика ОА по-прежнему остается основной, хотя многие широко применяемые аппендикулярные симптомы имеют низкую чувствительность и специфичность [1,16]. Данные общего анализа крови, ряд биохимических маркеров не дают повышения точности диагностики ОА [10,18,19,20]. Использование инструментальных методов зависит от уровня материально-технической и финансовой обеспеченности лечебного учреждения [3,4,8,16].…”