Mean Platelet Volume in the Diagnosis of Acute Appendicitis in the Pediatric Population: A Systematic Review and Meta-Analysis

Abstract

Background: Mean Platelet Volume (MPV) has been suggested as a biomarker for acute appendicitis (AA) in the adult population. The utility of MPV in pediatric AA remains vague. This systematic review and meta-analysis aimed to systematically summarize and compare all relevant data on MPV as a diagnostic biomarker for AA in children. Methods: Databases were systematically searched using keywords ((mean platelet volume) OR mpv) AND (appendicitis). The inclusion criteria were all comparative studies of MPV in children aged less than 18 years and diagnosed with AA. Two authors independently assessed the methodological quality using the Downs and Black scale. Results: We included fourteen studies in the final meta-analysis; most were retrospective. Eight studies compared the MPV values between AA and non-AA; four studies compared the same between AA and healthy controls; two studies compared the MPV values among all three groups. The estimated heterogeneity among the studies for all outcomes was high and statistically significant. The pooling the data showed no statistically significant difference in MPV (weighted mean difference (WMD) = −0.42, 95% CI = (−1.04, 0.20), p = 0.19) between AA and healthy controls or AA and non-AA cases (WMD = 0.01, 95% CI = (−0.15, 0.17), p = 0.90). Conclusion: While MPV levels seem to have some utility in adult AA diagnosis, MPV levels should not dictate treatment options in pediatric AA.

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

“…Recently, some studies have investigated the sensitivity of other laboratory markers in detecting the presence of AA in children. Anand et al reviewed the literature on red cell distribution width and mean platelet volume in separate systemic reviews, without identifying a clear role in diagnosing pediatric AA [ 34 , 35 , 36 ], whereas the pooling data showed significantly elevated levels of pentraxin-3 in AA compared to healthy controls [ 34 ]. In another meta-analysis, the same authors highlighted hyponatremia as an independent prognosticator of CAA [ 18 ].…”

Utility of Ischemia-Modified Albumin as a Biomarker for Acute Appendicitis: A Systematic Review and Meta-Analysis

“…The most frequently evaluated marker is CRP, which has been reported in studies to have a sensitivity and specificity of 100% and >80%, respectively [9]. Other markers that have been evaluated include mean platelet volume (MPV), white blood cell (WBC) count, ESR, red cell distribution width (RDW), Pentraxin-3, hyponatremia, and oxidative markers such as nitric oxide and myeloperoxidase, to name a few [10][11][12][13][33][34][35][36][37].…”

“…This, coupled with the low sensitivity and specificity of the available diagnostic criteria, underscores the fact that there is a need for the identification of biomarkers that can help clinicians in accurately diagnosing and prognosticating acute appendicitis with high sensitivity and specificity. Several markers with different sensitivity and specificity rates, e.g., including C-reactive protein (CRP), mean platelet volume (MPV), white blood cell (WBC) count, ESR and red cell distribution width (RDW), etc., have been explored for the diagnosis of acute appendicitis [9][10][11][12][13]. In addition, newer biomarkers, e.g., pentraxin-3, interleukin-6 (IL-6), calprotectin, serum bilirubin, leucine-rich-alpha-2-glycoprotein (LRG), and 5-hydroxyindoleacetic acid (5-HIAA), etc., have also been explored by some authors for an early diagnosis and predicting the outcomes in these patients [14][15][16][17][18][19][20].…”

Un comentario acerca de los marcadores de severidad de la apendicitis aguda

“…Krishnan y colaboradores (4) en su metaanálisis analizaron los niveles de volumen plaquetario medio (VPM) y hallaron que no hubo diferencia significativa en los niveles entre niños con apendicitis aguda en comparación con los controles sanos, lo que demostró la baja utilidad del VPM para el diagnóstico de esta entidad clínica. En contraste, Tullavardhana y colaboradores (5) en su metaanálisis refieren claramente que los valores más bajos de VPM pueden funcionar como un marcador para predecir la apendicitis aguda, pero no lograron demostrar una predicción para apendicitis aguda complicada y sugieren seguir utilizando sistemas de puntuación clínica.…”