Investigation of Serum Interleukin 6, High-Sensitivity C-Reactive Protein and White Blood Cell Levels during the Diagnosis and Treatment of Paediatric Appendicitis Patients Before and during the COVID-19 Pandemic

Abstract

Introduction: In this study, we prospectively investigated changes in serum interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP) and full white blood cell (WBC) counts during the diagnosis and treatment of paediatric patients with appendicitis. We also investigated the effects of the COVID-19 pandemic on the diagnosis and treatment processes of paediatric appendicitis patients. Materials and Methods: A non-perforated appendicitis group ( n = 110), a perforated appendicitis group ( n = 35) and an appendicitis + COVID-19 group ( n = 8) were formed. Blood samples were taken upon admission and every day until the three studied parameters returned to normal values. To investigate the effects of the COVID-19 pandemic on paediatric appendicitis patients, the perforated appendicitis rates and the times from the onset of the first symptoms to the operation before and during the pandemic were compared. Results: WBC, IL-6, and hsCRP dropped below the upper limits on the second postoperative day in the non-perforated appendicitis group, four to six days postoperatively in the perforated appendicitis group, and three to six days postoperatively in the appendicitis + COVID-19 group. These parameters were not within normal range in patients who developed complications during follow-up. The time from the onset of abdominal pain to the surgery was significantly longer during than before the pandemic in both the non-perforated appendicitis group and the perforated appendicitis group. Conclusions: Our results show that WBC, IL-6, and hsCRP are useful laboratory parameters that can complete clinical examinations in the diagnosis of appendicitis in paediatric patients and the identification of complications that may develop postoperatively.

Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review

“…Perforation rates increased by 18-19% on average during the pandemic in comparison to the previous three years [41]. Analogous results were also reported by another three authors [49,104,105]. Li et al observed protracted times from symptom onset to presentation during the pandemic (2.42 ± 2.5 vs. 1.87 ± 1.2 days), and more perforated cases (47% vs. 32%), but less time to incision [17].…”

“…Conversely, lower negative appendicectomy rates can be associated with either treating patients more easily with NOM or better diagnostic accuracy. However, improving diagnostic accuracy includes serial imaging, laboratory results and clinical examinations after an observation period; hence, inherent delays in this process can be assumed [9,49,92]. On a side note, achieving lower negative appendicectomy rates is interesting because it conserves resources and protects children from risks inherent to surgery [43,98].…”

Unveiling the Role of Inflammatory Mediators and Gut Microbiome in Appendicitis: Types and Applications in Clinical Scoring

“…Targeting IL-6 or its receptors may hold promise for therapeutic interventions. WBC, IL-6, and hsCRP are useful laboratory parameters that can complete clinical examinations in the diagnosis of appendicitis in pediatric patients and the identification of complications that may develop postoperatively [66].…”

“…This comprehensive analysis examines the current state of these diagnostic approaches, their feasibility in clinical settings, and their cost-effectiveness compared to traditional diagnostic methods. [66]. Elevated levels of these mediators have been associated with inflammation in appendicitis.…”