Serum neutrophil gelatinase-associated lipocalin (NGAL) as a diagnostic tool in pediatric acute appendicitis: a prospective validation study

Montero, Javier Arredondo; Antona, Giuseppa; Pascual, Carlos Bardají; Anaut, Mónica Bronte; Briones, Raquel Ros; Fernández‐Celis, Amaya; Marcotegui, Adriana Rivero; López‐Andrés, Natalia; Martín‐Calvo, Nerea

doi:10.1007/s00383-022-05197-w

Cited by 9 publications

(9 citation statements)

References 14 publications

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“…This study, which belongs to the BIDIAP cohort [ 20 , 21 ], is a prospective, observational study to determine the diagnostic performance of serum PTX3 in PAA. Three groups of pediatric patients were included in this study: (1) patients with no underlying pathology who underwent scheduled outpatient surgery, (2) patients with acute abdominal pain who presented to the emergency department with a suspected diagnosis of acute appendicitis and in whom the diagnosis was finally excluded—also defined as non-surgical abdominal pain (NSAP), and (3) patients with histologically confirmed diagnosis of acute appendicitis.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic performance of serum pentraxin-3 in pediatric acute appendicitis: a prospective diagnostic validation study

et al. 2022

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Introduction Pediatric acute appendicitis (PAA) is a pathology with a high rate of diagnostic error. The search for new diagnostic tools is justified by the high morbidity and healthcare costs associated with diagnostic error. Methods We designed a prospective study to validate serum pentraxin-3 (PTX3) as a diagnostic tool in PAA. Participants were divided into three groups: (1) patients with no underlying pathology (2) patients with non-surgical abdominal pain and (3) patients with a confirmed diagnosis of PAA. For further analyses, patients in group 3 were divided into complicated or uncomplicated PAA. Quantitative variables were expressed as medians and interquartile ranges and categorical variables as percentages. Quantitative variables were compared using the Kruskal–Wallis test and the Mann–Whitney U test. Diagnostic performance was evaluated with ROC curves. Results This study included 215 patients divided into group 1 (n = 63), group 2 (n = 53) and group 3 (n = 99). Median serum PTX3 values were 2.54 (1.70–2.95) ng/mL, 3.29 (2.19–7.64) ng/mL and 8.94 (6.16–14.05) in groups 1, 2 and 3, respectively (p = 0.001). Patients with complicated PAA showed significantly higher values than patients with uncomplicated PAA (p = 0.04). The AUC (group 2 vs. 3) was 0.77 (95% CI 0.69–0.85) and the best cut-off point was at 7.28 ng/mL, with a sensitivity of 61.3% and a specificity of 73.1%. The AUC (complicated vs. uncomplicated PAA) was 0.65 (95% CI 0.54–0.77) and the best cut-off point was 12.33 ng/mL, with a sensitivity of 51.72% and a specificity of 72.73%. Conclusions The diagnostic ability of serum PTX3 in PAA is only moderate and therefore it cannot be considered a definitive diagnostic test. The discriminatory ability of PTX3 between complicated and uncomplicated PAA is poor. These findings, which contrast with those reported to date, should be validated with future properly designed prospective studies.

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Section: Methodsmentioning

confidence: 99%

Diagnostic performance of serum pentraxin-3 in pediatric acute appendicitis: a prospective diagnostic validation study

et al. 2022

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“…This study, part of the BIDIAP cohort [ 13 – 15 ], included 151 patients, divided into two groups: (1) patients with non-surgical abdominal pain in whom the diagnosis of PAA was excluded ( n = 53) and (2) patients with a confirmed diagnosis of PAA ( n = 98). In 80 patients (group 1 = 23 patients, group 2 = 57 patients) a capillary ketone blood determination was obtained at the time of diagnosis.…”

Section: Resultsmentioning

confidence: 99%

“…This is a subanalysis of the BIDIAP study [ 13 , 14 ], an observational prospective study aimed to assess the diagnostic performance of several serum biomarkers in PAA. The objective of this subanalysis was to characterize the alterations in CK of patients with PAA and calculate its diagnostic performance.…”

Section: Methodsmentioning

confidence: 99%

Alterations and diagnostic performance of capillary ketonemia in pediatric acute appendicitis: a pilot study

et al. 2022

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Introduction The diagnostic performance of capillary ketonemia (CK) has been previously evaluated in context of pediatric acute gastroenteritis. To our knowledge, there is no literature on its performance in the setting of pediatric acute appendicitis (PAA). Materials and methods In this study, 151 patients were prospectively included and divided into two groups: (1) patients with non-surgical abdominal pain in whom the diagnosis of PAA was excluded (n = 53) and (2) patients with a confirmed diagnosis of PAA (n = 98). In 80 patients (Group 1, n = 23 and group 2, n = 57) a CK was measured at the time of diagnosis. The PAA group was further classified into complicated (n = 18) and uncomplicated PAA (n = 39). Quantitative variables were compared between groups using the Mann–Whitney U test. Diagnostic performance of CK was evaluated with ROC curves. Results CK values were 0.3 [0.1–0.9] mmol/L in group 1 and 0.7 [0.4–1.4] mmol/L in group 2 (p = 0.01). Regarding the type of PAA, CK values were 0.6 [0.4–0.9] mmol/L in uncomplicated PAA and 1.2 [0.8–1.4] mmol/L in complicated PAA (p = 0.02). The AUC for the discrimination between groups 1 and 2 was 0.68 (95% IC 0.53–0.82) (p = 0.24) and the AUC for the discrimination between uncomplicated PAA and complicated PAA was 0.69 (95% IC 0.54–0.85) (p = 0.04). The best cut-off point (group 1 vs group 2) resulted in 0.4 mmol/L, with a sensitivity of 80.7% and a specificity of 52.2%. The best cut-off point (non-complicated vs complicated PAA) resulted in 1.1 mmol/L, with a sensitivity of 61.1% and a specificity of 76.9%. Conclusions This study found significantly higher levels of CK in patients with PAA than in those with NSAP. Similarly, significantly higher levels were observed in patients with complicated than in those with uncomplicated PAA. Nevertheless, the diagnostic performance of CK was only moderate in the two settings analyzed. The potential usefulness of CK determination as a tool to guide the preoperative rehydration regimen of patients with PAA to prevent postoperative hyporexia and vomiting is a promising line of research and should be evaluated in future studies.

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“…In addition to standard biomarkers, several new biomarkers for acute appendicitis, such as hyponatremia, hyperfibrinogenemia, hyperbilirubinemia, pentraxin-3 (PTX-3), neutrophil gelatinase-associated lipocalin (NGAL), or interleukin-6 (IL-6), have recently been investigated. These biomarkers showed good predictive values for the detection of acute appendicitis, as well as for distinguishing between complicated and simple acute appendicitis [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. A more recent study showed that non-invasive markers from saliva, such as leucine-rich α-2-glycoprotein 1 (LRG1), may be promising biomarkers for the detection of acute appendicitis in children [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Daytime Versus Nighttime Laparoscopic Appendectomy in Children

et al. 2023

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Aim of the study: To evaluate the clinical outcomes and complication rate of laparoscopic appendectomy in children operated on during the daytime versus nighttime. Methods: A total of 303 children who underwent laparoscopic appendectomy for acute appendicitis between 1 January 2020 and 31 December 2022 were enrolled in this retrospective study. The patients were divided into two study groups. The first group consisted of the patients who underwent laparoscopic appendectomy during the day shift from 07:00–21:00 (n = 171), while the patients in the second group underwent laparoscopic appendectomy during the night shift from 21:00–07:00 (n = 132). The groups were compared for baseline clinical and laboratory data, treatment outcomes, and complications. The Mann–Whitney U test was used to compare continuous variables, while the Chi-square test was used to compare categorical variables. A two-sided Fisher’s exact test was used when the frequency of events in a certain cell was low. All p values less than 0.05 were considered significant. Results: The proportion of complicated appendicitis was almost the same in both patient groups (n = 63, 36.8% vs. n = 49, 37.1%, p = 0.960). Out of the total number of patients presenting during the daytime and nighttime, 11 (6.4%) and 10 (7.6%) developed a postoperative complication, respectively (p = 0.697). Additionally, rates of readmission (n = 5 (2.9%) vs. n = 2 (1.5%); p = 0.703), redo-surgery (n = 3 (1.7%) vs. n = 0; p = 0.260), conversion to open surgery (n = 0 vs. n = 1 (0.8%); p = 0.435) and length of hospital stay (n = 3 (IQR 1, 5) vs. n = 3 (IQR 2, 5); p = 0.368) did not differ significantly between daytime and nighttime appendectomies. The duration of the surgery was significantly shorter in patients presenting during the day than in those presenting at night (26 min (IQR 22, 40) vs. 37 min (31, 46); p < 0.001). Conclusions: Different shift times did not affect the treatment outcomes or complication rates for children receiving laparoscopic appendectomy.

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Serum neutrophil gelatinase-associated lipocalin (NGAL) as a diagnostic tool in pediatric acute appendicitis: a prospective validation study

Cited by 9 publications

References 14 publications

Diagnostic performance of serum pentraxin-3 in pediatric acute appendicitis: a prospective diagnostic validation study

Diagnostic performance of serum pentraxin-3 in pediatric acute appendicitis: a prospective diagnostic validation study

Alterations and diagnostic performance of capillary ketonemia in pediatric acute appendicitis: a pilot study

Clinical Outcomes of Daytime Versus Nighttime Laparoscopic Appendectomy in Children

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