Diagnostic value of serum hepcidin and total bilirubin, and neutrophil to lymphocyte ratio in the diagnosis of acute appendicitis in children

authors:

avatar hosein asadi ORCID , avatar Mirsalim Seyed Sadeghi , * , avatar Negin Haghshenas , avatar Sanaz Karimi , avatar Hamed Zandian

Koomesh: Vol.25, issue 6; 654-658
article type: issue_documents_importer
received: July 03, 2023
accepted: January 01, 2024

how to cite: asadi H, Seyed Sadeghi M, Haghshenas N, Karimi S, Zandian H. Diagnostic value of serum hepcidin and total bilirubin, and neutrophil to lymphocyte ratio in the diagnosis of acute appendicitis in children. koomesh. 2023;25(6):e152864. 

Abstract

Introduction: One of the most common causes of abdominal pain in children is acute appendicitis. This study aimed to determine the diagnostic value of serum hepcidin, total bilirubin and neutrophil to lymphocyte ratio in the diagnosis of acute appendicitis in children. Materials and Methods: This cross-sectional study was conducted on 87 patients aged 6 to 16 with acute abdominal and primary diagnosis of acute appendicitis in Fatemi Ardabil Hospital for 6 months. Laboratory indicators of bilirubin, neutrophil to lymphocyte ratio and, serum hepcidin level of patients were measured. Based on the results of the surgery, the patients were divided into two groups with appendicitis and without inflammation. Results: The mean serum hepcidin in the group with inflamed appendicitis was 33.63±5.84 and in the non-inflamed group it was 19.36±5.34. The average bilirubin in inflamed appendicitis was 1±0.54 and non-inflamed appendicitis was 0.74±0.29. The laboratory indicators of hepcidin, neutrophil, leukocyte, and the ratio of neutrophil to leukocyte were statistically significant in the two groups (P<0.001). The sensitivity of hepcidin was 47.1, the specificity 76.5, the positive predictive value 89.2, and the negative predictive value 26. Hyperbilirubinemia had a sensitivity of 41.4, a specificity of 82.4, a positive predictive value of 90.6, and a negative predictive value of 25.5. The ratio of neutrophils to lymphocytes had a sensitivity of 94.3, a specificity of 100, a positive predictive value of 100, and a negative predictive value of 80.9. Conclusion: Biomarkers level of total bilirubin, hepcidin, and neutrophil to lymphocyte ratio can be useful as clinical indicators in diagnosing complicated appendicitis in children.

References

  • 1.

    Craig S, Dalton S. Diagnosing appendicitis: what works, what does not and where to from here? J Paediatr Child Health 2015; 52: 168-173. [PubMed ID: 26437742]. https://doi.org/https://doi.org/10.1111/jpc.12998.

  • 2.

    Nevler A, Berger Y, Rabinovitz A, Zmora O, Shabtai M, Rosin D, et al. Diagnostic value of serum bilirubin and liver enzyme levels in acute appendicitis. Isr Med Assoc J 2018; 20: 176-181.

  • 3.

    Sevin MM, Knac E, akar E, Bayrak S, zakay A, Aren A, et al. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: an analysis of 3392 cases. Ulus Travma Acil Cerrahi Derg 2016; 22: 155-166.##https://doi.org/10.5505/tjtes.2016.54388.

  • 4.

    Amouzeshi A, Zarban A, Khodabakhshi M. Diagnostic value of clinical and laboratory symptoms in the diagnosis of acute appendicitis in patients with suspected acute appendicitis referring to Imam Reza Hospital in Birjand. J Surg Trauma 2020; 8: 151-155.##https://doi.org/10.32592/jsurgery.2020.8.4.104.

  • 5.

    Baradaran A, Naimi A, Pirpiran E, Akhlaghi M. Evaluation of diagnostic value of neutrophil to lymphocyte ratio in younger and older pediatrics suspect to acute appendicitis in Imam Hossein hospital. J Prev Epidemiol 2020; 5: 26-32.##https://doi.org/10.34172/jpe.2020.26.

  • 6.

    Ghadimi Mahani F, Alimadadi H, Memarian S, Gharib B. The clinical, laboratory and imaging tests in diagnosing acute appendicitis in children: a retrospective study in a tertiary university hospital in Tehran, Iran. J Iran Med Council 2023; 6: 315-320. (Persian)##https://doi.org/10.18502/jimc.v6i2.12241.

  • 7.

    Soltani M, Abdollahi A, Akrami M, Hassanzadeh J. In the diagnosis of acute appendicitis in patients referred to Shahid Faghihi hospital, Shiraz. J Health Sci Surveillance Sys 2018; 6: 173-118.

  • 8.

    Bonadio W, Shahid S, Vardi, L, Buckingham C, Kornblatt A, Free C, et al. A pre-operative clinical scoring system to distinguish perforation risk with pediatric appendicitis. J Pediatr Surg 2018; 53: 441-445. [PubMed ID: 28554816]. https://doi.org/https://doi.org/10.1016/j.jpedsurg.2017.05.017.

  • 9.

    Celik B, Nalcacioglu H, Ozcatal M, Altuner Torun Y. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department. Ulus Travma Acil Cerrahi Derg 2019; 25: 222-228.##https://doi.org/10.5505/tjtes.2018.06709.

  • 10.

    Amanollahi O, Tat S. The study of diagnostic value of elevation of serum amylase as a predictive factor for appendiceal perforation in children with acute appendicitis. Int J Pediatr 2018; 6: 7213-7217.

  • 11.

    Madani SH, Tarlan M, Mozafari H, Khazaei S, Shaveisi- Zadeh F, Mozafari S. Role of platelet parameters as a biomarker in diagnosis of acute appendicitis: A retrospective case-controlled study. J Acute Dis 2019; 8: 153-159.##https://doi.org/10.4103/2221-6189.263708.

  • 12.

    Bozorgi F, Alvandipour M, Montazer H, Golikhatir I, Khodabakhsh H, Karami M. Diagnostic value of hyperbilirubinemia in acute appendicitis. J Mazandaran Univ Med Sci 2016; 26: 27-33.

  • 13.

    Doan S, Dorter M, Kalafat UM, Bildik B, Yazc R, Sarc , Cander B. Diagnostic value of C-reactive protein/albumin ratio to differentiate simple versus complicated appendicitis. Eurasian J Emerg Med 2020; 19: 178-183.##https://doi.org/10.4274/eajem.galenos.2019.52385.

  • 14.

    Panagiotopoulou I, Parashar D, Lin R, Antonowicz S, Wells A, Bajwa F, et al. The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications. Ann R Coll Surg Engl 2013; 95: 215-221. [PubMed ID: 23827295 PMCid:PMC4165248]. https://doi.org/https://doi.org/10.1308/003588413X13511609957371.

  • 15.

    Martinelli M, Strisciuglio C, Alessandrella A. Serum hepcidin and iron absorption in paediatric inflammatory bowel disease. J Crohns Colitis 2016; 10: 566-574. [PubMed ID: 26733407 PMCid:PMC4957448]. https://doi.org/https://doi.org/10.1093/ecco-jcc/jjv242.

  • 16.

    Yapakci E, Tarcan A, Celik B, Ozbek N, Gurakan B. Serum pro- hepcidin levels in term and preterm newborns with sepsis. Pediatr Int 2009; 51: 289-292. [PubMed ID: 19405934]. https://doi.org/https://doi.org/10.1111/j.1442-200X.2008.02688.x.

  • 17.

    Park KH, Sawada T, Kosuge T, Kita J, Shimoda M, Tomosugi N, et al. Surgical inflammation induces hepcidin production after abdominal surgery. World J Surg 2012; 36: 800-806. [PubMed ID: 22350482]. https://doi.org/https://doi.org/10.1007/s00268-012-1473-8.

  • 18.

    Ilhan M, Sonmez R, Oner G, Kose M, Tukek T. Evaluation of the diagnostic accuracy of hepcidin and conventional biochemical markers as predictors in disease severity of intra-abdominal inflammation. Int J Surg Res Pract 2018; 5: 82-89.##https://doi.org/10.23937/2378-3397/1410082.

  • 19.

    Kaiser M, Schroeckenfuchs M, Castellani C, Warncke G, Till H, Singer G. The diagnostic value of hepcidin to predict the presence and severity of appendicitis in children. J Surg Res 2018; 222: 102-107. [PubMed ID: 29273360]. https://doi.org/https://doi.org/10.1016/j.jss.2017.10.021.

  • 20.

    Emmanuel A, Murchan P, Wilson I, Balfe P. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. Ann R Coll Surg Engl 2011; 93: 213-217. [PubMed ID: 21477433 PMCid:PMC3291137]. https://doi.org/https://doi.org/10.1308/147870811X566402.

  • 21.

    Estrada JJ, Petrosyan M, Barnhart J, Tao M, Sohn H, Towfigh S, et al. Hyperbilirubinemia in appendicitis: a new predictor of perforation. J Gastrointest surg 2007; 11: 714-718. [PubMed ID: 17436050]. https://doi.org/https://doi.org/10.1007/s11605-007-0156-5.

  • 22.

    Noh H, Chang S-J, Han A. The diagnostic values of preoperative laboratory markers in children with complicated appendicitis. J Korean Surg Soc 2012; 83: 237-241. [PubMed ID: 23091796 PMCid:PMC3467390]. https://doi.org/https://doi.org/10.4174/jkss.2012.83.4.237.

  • 23.

    Shimizu T, Ishizuka M, Kubota K. A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis. Surg today 2016; 46: 84-89. [PubMed ID: 25686778]. https://doi.org/https://doi.org/10.1007/s00595-015-1125-3.

  • 24.

    Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int surg 2013; 97: 299-304. [PubMed ID: 23294069 PMCid:PMC3727267]. https://doi.org/https://doi.org/10.9738/CC161.1.

  • 25.

    Yazici M, zkisacik S, ztan MO, Grsoy H. Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr 2010; 52: 400-406.

  • 26.

    Goodman DA, Goodman CB. Use of the neutrophil: lymphocyte ratio in the diagnosis of appendicitis. Am Surg 1995; 61: 257-259.

  • 27.

    elik B, Nalcacioglu H, Ozcatal M, Altuner TY. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department. Ulus Travma Acil Cerrahi Derg 2019; 25: 222-228.##https://doi.org/10.5505/tjtes.2018.06709.