Can Fetuin-A, CRP, and WBC Levels Be Predictive Values in the Diagnosis of Acute Appendicitis in Children with Abdominal Pain?

Abstract

Background: Acute appendicitis (AA) is the most common cause of emergency surgery. Therefore, perforation is common. Early diagnosis and new markers are needed. The aim of this study was to investigate the effects of plasma Fetuin-A (FA) levels in patients with an acute abdomen (AB). Material and Method: This prospective study included 107 patients younger than 16 years of age who were admitted to the emergency department for abdominal pain between January and December 2018. The patients who presented abdominal pain were divided into two groups as AA and other causes (OC) of AB. Patients with acute appendicitis; intraperitoneal, retrocolic/retrocecal, and appendicitis were divided into three groups. Additionally, the AA group was divided into two groups as perforated appendicitis and non-perforated appendicitis. Serum FA levels of the patients were evaluated in the emergency department. Results: In the AA group, C-reactive protein (CRP) and white blood cell (WBC) levels were higher, and FA levels were significantly lower than in the AB group. Intraperitoneal localization was 95.2% and perforation was frequent. When significant values in the univariate regression analysis for acute abdomen and perforation were compared in the multivariate regression analysis, CRP, WBC, and FA levels were found to be prognostic. Furthermore, decreased FA levels were associated with AA, while too greatly decreased FA levels were associated with the risk of perforation. Conclusion: Current diagnosis can be made by history, physical examination, laboratory, and imaging methods in appendicitis cases. While trying to diagnose AA in children, the FA, CRP, and WBC levels may be predictive values to identify risk factors.

Novel Molecular Biomarkers and Diagnosis of Acute Appendicitis in Children

“…It is thought to cause subclinical inflammation and cytokine release through its direct effect on human adipose tissue [62]. Current research confirms that levels of fetuin-A are significantly decreased for those with acute appendicitis [63]. In addition to decreased levels being associated with appendicitis in children, one study demonstrated that severely decreased levels were also associated with risk of perforation [63].…”

“…Current research confirms that levels of fetuin-A are significantly decreased for those with acute appendicitis [63]. In addition to decreased levels being associated with appendicitis in children, one study demonstrated that severely decreased levels were also associated with risk of perforation [63]. However, in order to confirm these results prospective randomized trials with more patient groups need to be completed.…”

Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score)

“…CRP alone as a marker does not have a high accuracy for diagnosing AA, but in combination with other markers its accuracy is much greater. Also, a low CRP value should be explained with caution if symptoms have only developed recently, as it seems to increase after 10–12 h of the initial symptoms [ 32 , 34 , 35 ]. In the present study, a CRP value equal or higher than 1.99 was statistically significant enough to be in the multivariate analysis of the model and became one of the indicators that make up the CLU score.…”

Value of laboratory investigation data for the diagnostic of acute appendicitis in children

“…Основну увагу хірурги звертають на показники лейкоцитозу і наявність/відсутність зсуву лейкоцитарної формули вліво. Водночас, високі показники лейкоцитозу не завжди є свідченням ГА [3,13], а крім того, кількість лейкоцитів має недостатню прогностичну значущість щодо виокремлення пацієнтів із перфоративним ГА [14].…”

“…Наявність розлитого болю, дифузного напруження м'язів передньої черевної стінки та високий лейкоцитоз не у всіх дітей є свідченням перфорації червоподібного відростка, що підтверджують і літературні джерела [6,12,14]. Результати дослідження показали, що ні лейкоцитоз, ні кількість нейтрофілів не дають можливості з високим ступенем достовірності виявити пацієнтів із можливою перфорацією червоподібного відростка, що підтверджують дані літератури [6,[12][13][14]. Водночас, СНЛ надає можливість, у більшості випадків, передбачити до операції наявність у дитини перфоративного ГА, що узгоджується із літературними джерелами [5,14,19].…”