Pediatric Surgery Department, Hospital Universitario de Navarra, Pamplona, Spain.
Pathology Department, Hospital Universitario de Navarra, Pamplona, Spain.
Eur J Trauma Emerg Surg. 2023 Apr;49(2):763-773. doi: 10.1007/s00068-022-02000-2. Epub 2022 May 28.
Pediatric acute appendicitis (AA) is a challenging pathology to diagnose. In the last decades, multiple biomarkers have been evaluated in different human biological samples to improve diagnostic performance. This study aimed to examine the diagnostic performance of serum, fecal and urinary calprotectin as well as the role of the APPY-1 biomarker panel in pediatric acute appendicitis.
We conducted a systematic review of the literature that involved an extensive search in the main databases of medical bibliography (Medline, PubMed, Web of Science and SciELO). Two independent reviewers selected the relevant articles based on the previously defined inclusion and exclusion criteria. Methodological quality of the selected article was rated using the QUADAS2 index. Data extraction was performed by two independent reviewers. A synthesis of the results, a standardization of the metrics and two random-effect meta-analyses, one for serum calprotectin and one for APPY-1, were performed.
The research resulted in 173 articles. Thirty-eight duplicates were removed. Among the remaining 135 articles, we excluded 125 following the inclusion and exclusion criteria, resulting in the 10 studies included in this review. This systematic review included data from of 3901 participants (1276 patients with confirmed diagnosis of AA and 2625 controls). The age of the participants ranged from 0 to 21 years. Four of the studies compared serum calprotectin values and reported significant differences between groups, but inconsistent results regarding cutoff points, sensitivity and specificity. Two publications compared urinary values of calprotectin and presented inconsistent results regarding sensitivity and specificity as well. One publication evaluated the diagnostic performance of fecal calprotectin, but it did not provide data on measured values. Four studies evaluated the diagnostic performance of APPY-1 test in pediatric acute appendicitis. The calculated pooled sensitivity and specificity of those studies were 97.37 (95% CI 95.60-98.44) and 36.74 (95% CI 32.28-41.44), respectively, and the calculated pooled NLR, 0.0714 (95% CI 0.041-0.115).
Serum calprotectin has limited diagnostic yield in pediatric acute appendicitis. Its performance seems to increase with the hours of clinical evolution and in advanced AA, although the evidence is limited. There is not enough evidence on the usefulness of urinary or fecal calprotectin in the diagnosis of pediatric acute appendicitis. On the other hand, the APPY-1 is a reliable test to exclude the diagnosis of AA in patients at low or moderate risk according to PAS and Alvarado Score.
小儿急性阑尾炎（AA）是一种具有挑战性的病理诊断。在过去的几十年中，已经在多种人类生物样本中评估了多种生物标志物，以提高诊断性能。本研究旨在检查血清、粪便和尿液钙卫蛋白以及 APPY-1 生物标志物在小儿急性阑尾炎中的诊断性能。
我们进行了系统的文献综述，在医学文献的主要数据库（Medline、PubMed、Web of Science 和 SciELO）中进行了广泛的搜索。两名独立的评审员根据先前定义的纳入和排除标准选择了相关文章。使用 QUADAS2 指数评估选定文章的方法学质量。由两名独立的评审员进行数据提取。对结果进行综合，对指标进行标准化，并进行两项随机效应荟萃分析，一项针对血清钙卫蛋白，另一项针对 APPY-1。
研究结果产生了 173 篇文章。38 篇重复文章被删除。在剩余的 135 篇文章中，我们根据纳入和排除标准排除了 125 篇，最终有 10 项研究纳入本综述。这项系统综述包括了来自 3901 名参与者的数据（1276 名确诊为 AA 的患者和 2625 名对照组）。参与者的年龄从 0 岁到 21 岁不等。四项研究比较了血清钙卫蛋白值，报告了两组之间存在显著差异，但在截断值、敏感性和特异性方面结果不一致。两项出版物比较了尿液钙卫蛋白值，在敏感性和特异性方面也得出了不一致的结果。一项出版物评估了粪便钙卫蛋白在小儿急性阑尾炎中的诊断性能，但没有提供测量值的数据。四项研究评估了 APPY-1 测试在小儿急性阑尾炎中的诊断性能。这些研究的计算合并敏感性和特异性分别为 97.37%（95%CI 95.60-98.44）和 36.74%（95%CI 32.28-41.44），计算合并 NLR 为 0.0714（95%CI 0.041-0.115）。
血清钙卫蛋白在小儿急性阑尾炎中的诊断效果有限。其性能似乎随着临床病程的延长和急性阑尾炎的进展而增加，尽管证据有限。尿液或粪便钙卫蛋白在小儿急性阑尾炎诊断中的作用证据不足。另一方面，根据 PAS 和 Alvarado 评分，APPY-1 是一种可靠的测试，可以排除低或中度风险患者的 AA 诊断。
