ORIGINAL ARTICLE   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 November;178(11):861-7

DOI: 10.23736/S0393-3660.18.03636-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

The role of blood inflammatory markers in the diagnosis of appendicitis in children: a prospective study from a University Hospital in Greece

George SAKELLARIS ¹ ✉, Dimitra DIMOPOULOU ¹, Maria NINIRAKI ², Anastasia DIMOPOULOU ¹, Athanasios ALEGAKIS ³, Emmanouil K. SYMVOULAKIS ¹, Dimitra KOSTAKI ¹, Evangelos BLEVRAKIS ¹, Stavroula KOLIVAKI ², Emmanouil CHRYSSOS ⁴

¹ Department of Pediatric Surgery, University General Hospital of Heraklion, Crete, Greece; ² Department of Immunology, University General Hospital of Heraklion, Crete, Greece; ³ Department of Toxicology, University General Hospital of Heraklion, Crete, Greece; ⁴ Department of General Surgery, University General Hospital of Heraklion, Crete, Greece

BACKGROUND: The diagnosis of acute appendicitis is often based on history, physical examination and laboratory findings. Most times, especially in young children, these tools are not enough to limit diagnostic uncertainty. Early accurate diagnosis of this disease would reduce the number of unnecessary appendectomies without increasing the rate of perforation. Although recent technological advances, such as ultra-sonography and computed tomography have been helpful in the accuracy of diagnosis, these modalities are not always available in all primary health-care centers and their use is controversial. So, there is the need for research in order to enhance diagnostic capacity.
METHODS: A prospective study of 32 children suspected for acute appendicitis was undertaken. Serum laboratory tests were measured before and after surgery. Also, 32 children diagnosed with any acute abdominal condition other than appendicitis, were compared to those diagnosed with appendicitis.
RESULTS: White Blood Cell (WBC) and neutrophils count, alpha-1 antitrypsin (a1-ATH), haptoglobin (HP) and C-reactive protein (CRP) levels were higher in children with appendicitis (P<0.05). Additionally, WBC, CRP, C3, C4, CD19 and CD20 counts were higher before surgery, while IgM, IgG, IgA, CD3 and CD4 counts were higher after surgery.
CONCLUSIONS: WBC, CRP, HP and a1-ATH are useful diagnostic markers for appendicitis, but only WBC and CRP for the recognition of possible post-operative complications. Further research is needed by enrolling larger pediatric series and by combining different diagnostic tools in order to assess diagnostic likelihood.

KEY WORDS: Appendicitis; Inflammation; Child