Milunović Klaudio Pjer, Stanišić Lada, Barić Tomislav, Meštrović Jakov, Todorić Davor, Domić Daniela Šupe, Jerončić Ana, Pogorelić Zenon
Department of Pediatric Surgery, University Hospital of Split, 21000 Split, Croatia.
Department of Medical Laboratory Diagnostics, University Hospital of Split, 21000 Split, Croatia.
Molecules. 2025 Aug 15;30(16):3392. doi: 10.3390/molecules30163392.
The aim of this study was to evaluate the diagnostic potential of salivary C-reactive protein (CRP) as a non-invasive biomarker for acute appendicitis in children and to compare its levels with those found in blood.
Salivary and serum CRP levels were measured in patients with histologically confirmed acute appendicitis ( = 46) and a control group with non-specific abdominal pain ( = 43). Diagnostic performance was evaluated using receiver-operating characteristic analysis, while the agreement between salivary and serum CRP levels was evaluated using Spearman's correlation and the Bland-Altman method.
Salivary CRP levels were significantly elevated in children with acute appendicitis than in controls (median 35.7 vs. 1.1 mg/L, < 0.001), closely mirroring serum CRP trends (median 44.3 mg/L vs. 1.1 mg/L, < 0.001). Moreover, they demonstrated excellent discriminatory power (Area Under the Curve; AUC = 0.97; 91.3% sensitivity, 95.4% specificity at the optimal cut-off of 6.95 mg/L), comparable to that of serum CRP (AUC = 0.98; 89.1% sensitivity and 95.4% specificity at 10.3 mg/L cut-off). Levels of CRP in serum and saliva were strongly correlated (Spearman's ρ = 0.963, < 0.001) and overall showed good agreement on Bland-Altman. Although larger discrepancies (>10 mg/L) occurred in 29% of cases, there was no consistent bias favoring either the salivary or serum CRP measurements.
Salivary CRP is a promising non-invasive biomarker for diagnosing acute appendicitis in children, demonstrating diagnostic performance closely comparable to that of serum CRP and acceptable agreement between the two measures. This method may reduce the need for invasive blood sampling and streamline early evaluation in pediatric emergency settings.
本研究的目的是评估唾液C反应蛋白（CRP）作为儿童急性阑尾炎非侵入性生物标志物的诊断潜力，并将其水平与血液中的水平进行比较。
对组织学确诊为急性阑尾炎的患者（n = 46）和非特异性腹痛对照组（n = 43）测量唾液和血清CRP水平。使用受试者工作特征分析评估诊断性能，同时使用Spearman相关性和Bland-Altman方法评估唾液和血清CRP水平之间的一致性。
急性阑尾炎患儿的唾液CRP水平显著高于对照组（中位数35.7 vs. 1.1 mg/L，P < 0.001），与血清CRP趋势密切相关（中位数44.3 mg/L vs. 1.1 mg/L，P < 0.001）。此外，它们表现出出色的鉴别能力（曲线下面积；AUC = 0.97；在最佳截断值6.95 mg/L时灵敏度为91.3%，特异性为95.4%），与血清CRP相当（AUC = 0.98；在截断值10.3 mg/L时灵敏度为89.1%，特异性为95.4%）。血清和唾液中的CRP水平高度相关（Spearman's ρ = 0.963，P < 0.001），总体上在Bland-Altman分析中显示出良好的一致性。尽管29%的病例出现了较大差异（>10 mg/L），但在唾液或血清CRP测量方面没有一致的偏差。
唾液CRP是一种有前景的用于诊断儿童急性阑尾炎的非侵入性生物标志物，其诊断性能与血清CRP密切可比，且两种测量方法之间具有可接受的一致性。该方法可能减少侵入性血液采样的需求，并简化儿科急诊环境中的早期评估。
