IL-6 Serum Levels Can Enhance the Diagnostic Power of Standard Blood Tests for Acute Appendicitis

Abstract

Background: The diagnosis of acute appendicitis (AA) remains challenging, especially in pediatrics, because early symptoms are not specific, and the younger the patient the more difficult their interpretation is. There is a large degree of agreement between pediatric surgeons on the importance of an early diagnosis to avoid complicated acute appendicitis (CAA) and its consequences. The aim of this study is to assess if Interleukin 6 (IL-6) could enhance the sensitivity (Sn) and specificity (Sp) of the currently available and routinely performed diagnostic tools in case of suspected AA in pediatric patients. Materials and Methods: A prospective observational study was conducted including patients who underwent appendectomy between November 2020 and March 2022. We divided patients into three groups: not inflamed appendix (group NA), not complicated AA (group NCAA), and complicated AA (group CAA). We compared the mean values of white blood cells (WBC), neutrophils, fibrinogen, ferritin, aPTT, INR, C-reactive protein (CRP), IL-6, and CRP between the three groups. Then we evaluated Sn, Sp, and odds ratio (OR) of IL-6 and CRP alone and combined. Results: We enrolled 107 patients operated on for AA (22 in Group NA, 63 in Group NCAA, and 21 in group CAA). CRP levels resulted in a significant increase when comparing CAA with NA (p = 0.01) and CAA with NCAA (p = 0.01), whereas no significance was found between NA and NCAA (p = 0.38). A statistically significant increase in average IL-6 levels was found when comparing NCAA with NA (p = 0.04), CAA with NA (p = 0.04), and CAA with NCAA (p = 0.02). Considering CRP alone, its Sn, Sp, and OR in distinguishing NA from AA (both NCAA and CAA together) are 86%, 35%, and 33,17, respectively. Similarly, Sn, Sp, and OR of IL-6 alone are 82%, 54%, and 56, respectively. Combining CRP and IL-6 serum levels together, the Sn increases drastically to 100% with an Sp of 40% and OR of 77. Conclusions: Our study may suggest an important role of IL-6 in the detection of AA in its early stage, especially when coupled with CRP.

Associations between Th1-related cytokines and complicated pediatric appendicitis

“…The association between higher concentrations of IL-6 and complicated appendicitis is in line with the results from previous studies 28 – 30 . IL-6 is a pro-inflammatory cytokine produced by a variety of cells including macrophages, T cells, endothelial cells and fibroblasts, and stimulates the synthesis of acute phase reactants such as CRP, fibrinogen and serum amyloid A 31 .…”

“…Nevertheless, this study adds evidence supporting the previously indicated association between IL-6 and complicated appendicitis. However, the AUC for IL-6 was found to be 0.75, indicating only a moderate discriminatory ability in predicting complicated pediatric appendicitis, which is in line with previous studies that have found the AUC for IL-6 to be 0.70–0.77 28 – 30 . Studying the diagnostic property of IL-6 along with other diagnostic aids, such as clinical prediction scores, could offer valuable insights.…”

Associating Appendicitis with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Novel Insight into an Unexpected Connection

“…Appendicitis, a common surgical emergency affecting millions of people worldwide, has historically been viewed as an isolated condition, with its resolution by appendectomy typically considered a definitive cure [ 5 , 6 ]. Recently, several biochemical markers including IL-6 (which is synthesized in the liver) and bilirubin have been established to predict a complicated clinical course, e.g., due to organ perforation [ 7 , 8 , 9 ]. A growing body of research has shed new light on the long-term consequences of appendicitis beyond the acute phase.…”

A Bizarre Cause of Acute Appendicitis in a Pediatric Patient: An Ingested Tooth

“…In addition to physical examination and image diagnosis, numerous laboratory markers such as white blood cells, neutrophil granulocytes, C-reactive protein, interleukins, sodium, bilirubin, red blood cell distribution width, mean platelet volume, etc. [4][5][6][7][8], as well as various scoring scales, help us to diagnose acute appendicitis [9][10][11]. Although acute appendicitis is the most common surgical abdominal pathology in children, it is still a challenge and diagnostic dilemma for pediatric surgeons despite all available diagnostic modalities.…”