Bueso-Inchausti García Leticia, Arias Bueso-Inchausti Patricia, Rosario Cuenca Lucía, García-Gámiz Mercedes, Fanjul Gómez María, Marañon Rafael, Jové-Blanco Ana
Paediatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Laboratory Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Eur J Pediatr. 2025 Aug 14;184(9):550. doi: 10.1007/s00431-025-06391-3.
Copeptin has shown to correlate with acute appendicitis (AA) in adults. Its usefulness in the diagnosis of paediatric patients with suspected AA is unknown. The purpose of this study is to analyse the role of copeptin in the diagnosis of AA in children and to compare its diagnostic utility with other biomarkers. A prospective, observational, analytical, single-centre study was conducted in a Paediatric Emergency Department (PED) between June 2023 and May 2024. We included patients under 16 years presenting at the PED with acute abdominal pain (AAP) and clinical suspicion of AA after initial medical assessment. Patients with abdominal pain > 7 days were excluded. AA was defined as having a clinical diagnosis confirmed by histopathological examination. The diagnostic performance of copeptin and other biomarkers was analysed using ROC curves. Cut-off points were established according to the Youden index, and their usefulness was compared by sensitivity, specificity, and positive and negative predictive values (PPV, NPV). We report results from 246 patients [mean age 10.43 years (SD: 3.13)], of whom 60 (24.39%) had AA. The median copeptin level was 8.70 pmol/L (RIC 5.20-17.50), among patients with AA 15.20 pmol/L (RIC 7.40-31.70) and without AA 7.70 pmol/L (RIC 4.80-12.90) (p < 0.001). The area under the curve was 0.69 (95%CI: 0.61-0.77) for copeptin, 0.84 (95%CI: 0.79-0.89) for leukocytes, 0.84 (95%CI: 0.79-0.89) for neutrophils, and 0.70 (95%CI: 0.63-0.77) for C-reactive protein (CRP). The combination of biomarkers that showed the best diagnostic performance was leukocytes + CRP (sensitivity 96.67%, specificity 51.61%, PPV 39.19%, and NPV 97.96%).
Copeptin in association with other biomarkers (leukocytosis and neutrophilia) could be useful to rule out AA.
• To date, none of the existing inflammatory biomarkers or their combinations have demonstrated consistent predictive value for the early diagnosis of acute appendicitis (AA) in paediatric population. • In recent years, studies in adults have examined various inflammatory molecules such as copeptin. Elevated copeptin levels have been associated with disease severity and mortality in different conditions.
• Isolated copeptin values have limited utility as a biomarker for paediatric AA compared to existing biomarkers. • However, when combined with other biomarkers such as leukocytes or neutrophils, copeptin may help rule out AA.
copeptin已被证明与成人急性阑尾炎（AA）相关。其在疑似AA的儿科患者诊断中的效用尚不清楚。本研究的目的是分析copeptin在儿童AA诊断中的作用，并将其诊断效用与其他生物标志物进行比较。2023年6月至2024年5月期间，在一家儿科急诊科（PED）进行了一项前瞻性、观察性、分析性单中心研究。我们纳入了16岁以下因急性腹痛（AAP）就诊于PED且经初步医学评估后临床怀疑为AA的患者。腹痛超过7天的患者被排除。AA被定义为经组织病理学检查确诊的临床诊断。使用ROC曲线分析copeptin和其他生物标志物的诊断性能。根据约登指数确定截断点，并通过敏感性、特异性、阳性和阴性预测值（PPV、NPV）比较其效用。我们报告了246例患者的结果[平均年龄10.43岁（标准差：3.13）]，其中60例（24.39%）患有AA。AA患者中copeptin水平的中位数为15.20 pmol/L（四分位间距5.20 - 17.50），非AA患者中为7.70 pmol/L（四分位间距4.80 - 12.90）（p < 0.001）。copeptin的曲线下面积为0.69（95%置信区间：0.61 - 0.77），白细胞为0.84（95%置信区间：0.79 - 0.89），中性粒细胞为0.84（95%置信区间：0.79 - 0.89），C反应蛋白（CRP）为0.70（95%置信区间：0.63 - 0.77）。显示出最佳诊断性能的生物标志物组合是白细胞 + CRP（敏感性96.67%，特异性51.61%，PPV 39.19%，NPV 97.96%）。
copeptin与其他生物标志物（白细胞增多和中性粒细胞增多）联合使用可能有助于排除AA。
• 迄今为止，现有的炎症生物标志物或其组合均未在儿科人群中对急性阑尾炎（AA）的早期诊断显示出一致的预测价值。
• 近年来，针对成人的研究考察了各种炎症分子，如copeptin。copeptin水平升高与不同疾病状态下的疾病严重程度和死亡率相关。
• 与现有生物标志物相比，单独的copeptin值作为儿科AA的生物标志物效用有限。
• 然而，当与白细胞或中性粒细胞等其他生物标志物联合使用时，copeptin可能有助于排除AA。
