Correlation of Acute Appendicitis and Acute Mesenteric Lymphadenitis with the Changes of Serum Cytokines in Children. Summary of the Doctoral Thesis

Abstract

The Aim of the study. To analyse the incidence changes for Acute Appendicitis (AA) and Acute Mesenteric lymphadenitis (AML), and to ascertain the compatibility of hospital admission and discharge diagnosis, as well as to investigate cytokine group serum inflammation mediator (CGSIM), epithelial growth factor (EGF), interleukine (IL)-10 IL-12 (p 70), IL-1β , IL-4, IL-6, IL-17, IL-8, monocyte hemotaxis protein 1 (MCP-1), tumour necrosis factor α (TNF-α) differential diagnostic value and to evaluate the connection between biomarkers and other diagnostic methods in case of AA and AML in children. Methods. Mixed type prospective case-control study. In the retrospective part of the thesis, data regarding incidence of AA and AML have been analysed, in time period from year 2010 until year 2013. A retrospective analysis for patients (n = 1228) in the age group from 0 to 18 years during first time hospital admissions Children’s Clinical University Hospital with suspicion of AA and admission and discharge diagnosis compatibility has been carried out (01.10.2010 – 01.10.2013). The prospective part of the study includes 57 patients (31 with AA and 26 with AML), that were compatible with the inclusion criteria, with addition of using control group (n = 17) for establishing CGSIM reference value. The main results of the study. During the time period (2010 – 2013) the incidence of AA in children (7–18 years of age) was on average diminished by 2%, however, the incidence for AML has risen on average by 5.8%. Hospital data revealed, that there is inconsistency of 76.2% of cases admission and discharge diagnosis for patients with suspicion of AA in the age group until 18 years. Comparing the clinical signs of the patients symptoms like nausea, vomiting, abdominal wall rigidity, and rebound tenderness they were more compatible with AA comparing to AML. The results of CGSIM and the rest of diagnostic methods revealed, that the diagnostic accuracy of AA increases to 89.5%, if the patients are clinically evaluated for Alvarado score ≥ 7 and laboratory criteria, taking in account cut-off values of these variables – WBC ≥ 10.7 × 10^3/μL un IL-6 ≥ 4.3 pg/mL. In the case of Alvarado score being ≥ 7, IL-6 with cut-off value in serum ≥ 4.3 pg/mL and additional ultrasound examination, combination of these criteria showed a 100% specificity and 100% PPV during precision of AA diagnosis. During analysis of CGSIM concentration changes in case of complicated and uncomplicated AA, inflammation marker, such as IL-6, IL-8, MCP-1, CRP, increased concentration was established in case of complicated AA. The serum level of IL-6 with cut-off level of ≥ 36.2 pg/mL, IL-8 ≥ 12.3 pg/mL and MCP-1 ≥ 400.2 pg/mL indicates the presence of complicated AA. Correlation analysis of IL-6 revealed a medium close connection between IL-8 and MCP-1 in case of AA. Conclusions. CGSIM concentration level varies in case of AA and AML in children, age group from 7 to 18 years. The main CGSIM in previously mentioned disease differential diagnosis is IL-6, that, together with other examination methods increases the diagnostic accuracy of AA. Pending clinical evaluation of children with AA and AML and establishing further tactic for prognosis and action of AA, patients should be evaluated using Alvarado score of ≥ 7 together with laboratory findings, taking into account the WBC ≥ 10.7 × 10^3/μL un IL-6 ≥ 4.3 pg/mL. Based on the results of the study, an algorithm suitable for AA prognosis and action in children in age group from 7 to 18 years was established to be used in hospital admission wards and out-patients units.