Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China.
Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University, (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
Int J Colorectal Dis. 2023 Mar 17;38(1):72. doi: 10.1007/s00384-023-04362-4.
The aim of this study was to investigate the predictive value of hyperfibrinogenemia and hyponatremia for perforated appendicitis in children.
A retrospective review of 521 pediatric patients (≤ 15 years) with acute appendicitis confirmed by histopathology from January 2017 to December 2020 was performed. Patients were divided in two groups, those with non-perforated (n = 379; 73%) and perforated appendicitis (n = 142; 27%). The serum values of sodium and fibrinogen were taken before surgery. We performed the receiver operating characteristic analysis for the two biochemical markers. The sensitivity, specificity, positive and negative predictive values for perforated appendicitis in the presence of hyponatremia and hyperfibrinogenemia were calculated.
Hyperfibrinogenemia (≥ 4.0 g/L) was found in 58.45% of perforated appendicitis and 104 of 142 (73.34%) children with perforated appendicitis had hyponatremia (≤ 135 mmol/L). The perforated appendicitis group had a higher mean fibrinogen concentration (P = 0.001). There was a statistically significant difference in mean serum sodium levels between the perforated appendicitis and non-perforated appendicitis groups (P = 0.016). Receiver operating characteristic curve analysis for fibrinogen, sodium and combination of the both markers shown the combination had the largest area under the curve in identifying children with perforated acute appendicitis (0.858) (95% CI, 0.82-0.90) compared with fibrinogen (0.815) (95% CI, 0.77-0.86) and sodium 0.818 (95% CI, 0.78-0.86) alone. Furthermore, the combination of both markers had the best positive and negative predictive value for appendix perforation compared to fibrinogen and sodium.
Hyponatremia and/or hyperfibrinogenemia are excellent markers for predicting perforated appendicitis in children. We propose that plasma sodium and/or fibrinogen concentrations be utilized as a supplementary to guide individual treatment decisions in children with appendicitis, such as surgery timing and nonoperative management options.
本研究旨在探讨高纤维蛋白原血症和低钠血症对儿童穿孔性阑尾炎的预测价值。
回顾性分析 2017 年 1 月至 2020 年 12 月期间经组织病理学证实的 521 例（≤15 岁）急性阑尾炎患儿的临床资料。患儿分为非穿孔性（n=379；73%）和穿孔性阑尾炎（n=142；27%）两组。术前检测血清钠和纤维蛋白原值。对两种生化标志物进行受试者工作特征曲线分析。计算低钠血症和高纤维蛋白原血症并存时对穿孔性阑尾炎的敏感性、特异性、阳性预测值和阴性预测值。
穿孔性阑尾炎组中 58.45%（n=84）患儿存在高纤维蛋白原血症（≥4.0g/L），142 例穿孔性阑尾炎患儿中有 104 例（73.34%）存在低钠血症（≤135mmol/L）。穿孔性阑尾炎组的纤维蛋白原浓度均值显著高于非穿孔性阑尾炎组（P=0.001）。穿孔性阑尾炎组和非穿孔性阑尾炎组的血清钠水平均值差异有统计学意义（P=0.016）。纤维蛋白原、血清钠及两者联合检测对儿童穿孔性急性阑尾炎的诊断价值进行受试者工作特征曲线分析，结果显示纤维蛋白原联合血清钠检测对儿童穿孔性急性阑尾炎的诊断效能最高（曲线下面积 0.858，95%可信区间 0.82-0.90），优于纤维蛋白原（0.815，95%可信区间 0.77-0.86）和血清钠（0.818，95%可信区间 0.78-0.86）单独检测。此外，与纤维蛋白原和血清钠相比，两种标志物联合检测对阑尾穿孔具有最佳的阳性和阴性预测值。
低钠血症和/或高纤维蛋白原血症是预测儿童穿孔性阑尾炎的优秀标志物。我们建议在儿童阑尾炎的治疗决策中，如手术时机和非手术治疗方案的选择，将血浆钠和/或纤维蛋白原浓度作为补充指标加以利用。
