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Hematolojik Belirteçlerin Pediatrik Apandisitte Tanısal Rolü: Gizemini Koruyor

Year 2024, Volume: 14 Issue: 2, 210 - 214, 22.05.2024
https://doi.org/10.33631/sabd.1375419

Abstract

Amaç: Apandisit tanısı pediyatrik popülasyonda zor olabilir. Çocukları muayene etmek veya hikaye almak oldukça zor olabilmektedir. Laboratuvar bulgularının rolü hala belirsizdir. Bu nedenle beyaz kan hücresi, nötrofil / eozinofil oranı ve nötrofil / lenfosit oranı gibi hematolojik parametrelerin tanısal değerinin değerlendirilmesi amaçlandı.
Gereç ve Yöntemler: Şubat 2018 ile Şubat 2020 arasında apandisit şüphesiyle ameliyat edilen hastalar retrospektif olarak incelendi. Ameliyat öncesi veriler hasta kayıtlarından toplandı. Apandisit tanısında histopatolojik değerlendirme altın standart olarak kabul edildi.
Bulgular: Çalışma popülasyonu, yaş ortalaması 11,95±3,68 yıl idi, % 56,25'i (n=207) erkek olmak üzere 368 hastadan oluşmaktadır. Patolojik inceleme hastaların % 63,6'sının (n=234) akut apandisit,% 18,5'inin (n=68) flegmonöz ve % 8,7'sinin (n=32) perfore olduğunu ortaya koydu. Akut apandisitte beyaz kan hücreleri, nötrofil-eozinofil oranı ve nötrofil-lenfosit oranı tanısal değildi. Öte yandan, aynı parametreler flegmonöz ve perfore apandisiti ayırt etmede yararlı belirteçlerdir.
Sonuç: Akut apandisit için spesifik bir biyobelirteç yoktur. Beyaz kan hücresi sayısı skorlama sistemlerinde iyi bilinen bir parametre olmasına rağmen, cerraha yol gösterme kabiliyetine sahip değildir. Nötrofil / eozinofil oranı, flegmonöz ve perfore apandisit için yeni bir tanı indeksi olabilir. Bir çocuğun apandisit olup olmadığını anlamak bazen cerrahları zorlamaktadır. Klinik semptomlar, skorlama sistemleri, görüntüleme yöntemleri ve laboratuvar yardımcı olsa da cerraha tanı koyduracak spesifik bir yöntem veya marker bulunmamaktadır.

References

  • Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990; 132(5): 910-25.
  • O’Toole SJ, Karamanoukian HL, Allen JE, Caty M G, O’Toole D, Azizkhan RG, et al. Insurance-related differences in the presentation of pediatric appendicitis. J Pediatr Surg. 1996; 31(8): 1032-4.
  • Flum DR, Morris A, Koepsell T, Dellinger E P. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001; 286(14): 1748-53.
  • Dalal I, Somekh E, Bilker-Reich A, Boaz M, Gorenstein A, Serour F. Serum and peritoneal inflammatory mediators in children with suspected acute appendicitis. Arch Surg. 2005; 140(2): 169-73.
  • Gronroos JM, Gronroos P. Leukocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg. 1999; 86(4): 501-4.
  • Lycopoulou L, Mamoulakis C, Hantzi E, Demetriadis D, Antypas S, Giannaki M, et al. Serum amyloid A protein levels as a possible aid in the diagnosis of acute appendicitis in children. Clin Chem Lab Med. 2005; 43(1): 49-53.
  • Gil H, Magy N, Mauny F, Dupond J-L Value of eosinopenia in inflammatory disorders: an « old » marker revisited. Rev Med Interne. 2003; 24(7): 431-5.
  • Kaminsky P, Deibener J, Lesesve JF, Humbert J C. Changes in hemogram parameters in infections. Rev Med Interne. 2002; 23(2): 132-6.
  • Deibener-Kaminsky J, Lesesve J F, Grosset S, Pruna L, Schmall-Laurain M C, Benetos A, et al. Clinical relevance of leukocyte differential in patients with marked leukocytosis in the emergency room. Rev Med Interne. 2011; 32(7): 406-10.
  • Dalal I, Somekh E, Bilker-Reich A, Boaz M, Gorestein A, Serour F. Serum and peritoneal inflammatory mediators in children with suspected acute appendicitis. Arch Surg. 2005; 140(2): 169-73.
  • Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004; 91(1): 28-37.
  • Lycopoulou L, Mamoulakis C, Hantzi E, Demetriadis D, Antypas S, Giannaki M, et al. Serum amyloid A protein levels as a possible aid in the diagnosis of acute appendicitis in children. Clin Chem Lab Med. 2005; 43(1): 49-53.
  • Gronroos JM, Forsstrom JJ, Irjala K, Nevalainen T J. Phospholipase A2, Creactive protein, and white blood cell count in the diagnosis of acute appendicitis. Clin Chem. 1994; 40(9): 1757-60.
  • Eriksson S, Granstrom L, Olander B, Pira U. Leukocyte elastase as a marker in the diagnosis of acute appendicitis. Eur J Surg. 1995; 161(12): 901-5.
  • Gronroos JM. Do normal leukocyte count and C-reactive protein value exclude acute appendicitis in children? Acta Paediatr. 2001; 90(6): 649-51.
  • Paajanen H, Mansikka A, Laato M, Kettunen J, Kostiainen S. Are serum inflammatory markers age dependent in acute appendicitis? J Am Coll Surg. 1997; 184(3): 303-8.
  • Gronroos JM, Gronroos P. Leukocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg. 1999; 86(4): 501-4.
  • Yang HR, Wang YC, Chung PK, Chen W K, Jeng L B, Chen R J, et al. Laboratory tests in patients with acute appendicitis. ANZ J Surg. 2006; 76(1-2): 71-4.
  • Schellekens DHSM, Hulsewe KWE, van Acker BAC, van Bijnen AA, de Jaegere TMH, Sastrovijoto SH, et al. Evaluation of the diagnostic accuracy of plasma markers for early diagnosis in patients suspected for acute appendicitis. Acad Emerg Med. 2013; 20(7): 703-10.
  • Ravin KA, Loy M. The eosinophil in infection. Clin Rev Allergy Immunol. 2016; 50(2): 214-27.
  • Yazici M, Ozkisacik S, Oztan MO, Gürsoy H. Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr. 2010; 52(4): 400-3.
  • Zani A, Teague WJ, Clarke SA, Haddad MJ, Khurana S, Tsang T, et al. Can common serum biomarkers predict complicated appendicitis in children? Pediatr Surg Int. 2017; 33(7): 799-805.
  • Markar SR, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg. 2010; 110(5): 543-7.

Predictive Role of Hematological Markers on Pediatric Appendicitis: Still a Mystery

Year 2024, Volume: 14 Issue: 2, 210 - 214, 22.05.2024
https://doi.org/10.33631/sabd.1375419

Abstract

Aim: The diagnosis of appendicitis may be challenging in the pediatric population. It can be very difficult to examine a child or to take a medical history. The role of laboratory findings is still unclear. Therefore, we aimed to evaluate the diagnostic value of hematological parameters such as white blood cell, neutrophil to eosinophil ratio, and neutrophil to lymphocyte ratio.
Material and Methods: We retrospectively analyzed patients who underwent surgery with suspected appendicitis between February 2018 and February 2020. Preoperative data were gathered from patient records. Histopathological assessment was accepted as the gold standard in the diagnosis of appendicitis.
Results: The study population consists of 368 patients with a mean age of 11.95±3.68 years, 56.25% (n=207) of whom were male. The pathological examination revealed that 63.6% (n=234) of the patients were acute appendicitis, 18.5% (n=68) phlegmonous, and 8.7% (n=32) perforated. White blood cells, neutrophil-eosinophil ratio, and neutrophil-lymphocyte ratio were not diagnostic in acute appendicitis. On the other hand, the same parameters are useful markers in differentiating phlegmonous and perforated appendicitis.
Conclusion: There is no established biomarker for acute appendicitis. Although the white blood cell count is a well-known parameter in scoring systems, it is not capable of guiding the surgeon. The neutrophil to eosinophil ratio may be a novel diagnostic index for phlegmonous and perforated appendicitis. Understanding whether a child is experiencing appendicitis is still a diagnostic challenge for the clinician. Although clinical symptoms, scoring systems, and imaging methods and laboratory tests are important in the diagnosis of appendicitis, there are not any specific markers helping the surgeon.

References

  • Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990; 132(5): 910-25.
  • O’Toole SJ, Karamanoukian HL, Allen JE, Caty M G, O’Toole D, Azizkhan RG, et al. Insurance-related differences in the presentation of pediatric appendicitis. J Pediatr Surg. 1996; 31(8): 1032-4.
  • Flum DR, Morris A, Koepsell T, Dellinger E P. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001; 286(14): 1748-53.
  • Dalal I, Somekh E, Bilker-Reich A, Boaz M, Gorenstein A, Serour F. Serum and peritoneal inflammatory mediators in children with suspected acute appendicitis. Arch Surg. 2005; 140(2): 169-73.
  • Gronroos JM, Gronroos P. Leukocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg. 1999; 86(4): 501-4.
  • Lycopoulou L, Mamoulakis C, Hantzi E, Demetriadis D, Antypas S, Giannaki M, et al. Serum amyloid A protein levels as a possible aid in the diagnosis of acute appendicitis in children. Clin Chem Lab Med. 2005; 43(1): 49-53.
  • Gil H, Magy N, Mauny F, Dupond J-L Value of eosinopenia in inflammatory disorders: an « old » marker revisited. Rev Med Interne. 2003; 24(7): 431-5.
  • Kaminsky P, Deibener J, Lesesve JF, Humbert J C. Changes in hemogram parameters in infections. Rev Med Interne. 2002; 23(2): 132-6.
  • Deibener-Kaminsky J, Lesesve J F, Grosset S, Pruna L, Schmall-Laurain M C, Benetos A, et al. Clinical relevance of leukocyte differential in patients with marked leukocytosis in the emergency room. Rev Med Interne. 2011; 32(7): 406-10.
  • Dalal I, Somekh E, Bilker-Reich A, Boaz M, Gorestein A, Serour F. Serum and peritoneal inflammatory mediators in children with suspected acute appendicitis. Arch Surg. 2005; 140(2): 169-73.
  • Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004; 91(1): 28-37.
  • Lycopoulou L, Mamoulakis C, Hantzi E, Demetriadis D, Antypas S, Giannaki M, et al. Serum amyloid A protein levels as a possible aid in the diagnosis of acute appendicitis in children. Clin Chem Lab Med. 2005; 43(1): 49-53.
  • Gronroos JM, Forsstrom JJ, Irjala K, Nevalainen T J. Phospholipase A2, Creactive protein, and white blood cell count in the diagnosis of acute appendicitis. Clin Chem. 1994; 40(9): 1757-60.
  • Eriksson S, Granstrom L, Olander B, Pira U. Leukocyte elastase as a marker in the diagnosis of acute appendicitis. Eur J Surg. 1995; 161(12): 901-5.
  • Gronroos JM. Do normal leukocyte count and C-reactive protein value exclude acute appendicitis in children? Acta Paediatr. 2001; 90(6): 649-51.
  • Paajanen H, Mansikka A, Laato M, Kettunen J, Kostiainen S. Are serum inflammatory markers age dependent in acute appendicitis? J Am Coll Surg. 1997; 184(3): 303-8.
  • Gronroos JM, Gronroos P. Leukocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg. 1999; 86(4): 501-4.
  • Yang HR, Wang YC, Chung PK, Chen W K, Jeng L B, Chen R J, et al. Laboratory tests in patients with acute appendicitis. ANZ J Surg. 2006; 76(1-2): 71-4.
  • Schellekens DHSM, Hulsewe KWE, van Acker BAC, van Bijnen AA, de Jaegere TMH, Sastrovijoto SH, et al. Evaluation of the diagnostic accuracy of plasma markers for early diagnosis in patients suspected for acute appendicitis. Acad Emerg Med. 2013; 20(7): 703-10.
  • Ravin KA, Loy M. The eosinophil in infection. Clin Rev Allergy Immunol. 2016; 50(2): 214-27.
  • Yazici M, Ozkisacik S, Oztan MO, Gürsoy H. Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr. 2010; 52(4): 400-3.
  • Zani A, Teague WJ, Clarke SA, Haddad MJ, Khurana S, Tsang T, et al. Can common serum biomarkers predict complicated appendicitis in children? Pediatr Surg Int. 2017; 33(7): 799-805.
  • Markar SR, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg. 2010; 110(5): 543-7.
There are 23 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Research Articles
Authors

Ayşe Betül Öztürk 0000-0001-7773-5978

Cengizhan Kılıçaslan 0000-0002-6093-7132

Sibel Çiğdem Tuncer 0000-0002-6250-5093

Publication Date May 22, 2024
Submission Date October 13, 2023
Acceptance Date April 3, 2024
Published in Issue Year 2024 Volume: 14 Issue: 2

Cite

Vancouver Öztürk AB, Kılıçaslan C, Tuncer SÇ. Predictive Role of Hematological Markers on Pediatric Appendicitis: Still a Mystery. VHS. 2024;14(2):210-4.