Hyperbilirubinemia as an Indicator of Perforated Acute Appendicitis in Pediatric Population: A Prospective Study
Hyperbilirubinemia as an Indicator of Perforated Acute Appendicitis in Pediatric Population: A Prospective Study
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DOI：
10.1089/sur.2021.107
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发表时间：
2021-08-09
影响因子：
2
通讯作者：
Balta, Vedran
中科院分区：
文献类型：
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作者：
Pogorelic, Zenon;Luksic, Ana Marija;Balta, Vedran
背景：这项前瞻性队列研究旨在调查儿童人群中高胆红素血症与穿孔性阑尾炎的关系。患者和方法：本研究共纳入284例确诊为急性阑尾炎的儿童。根据手术结果，患者被分配到研究组。第一组包括穿孔性阑尾炎患者(，22.5%)，第二组患者为单纯性阑尾炎(n=220，77.5%)。患者手术前采集血清胆红素水平和急性炎症标志物的血样。研究的主要结果是调查血清胆红素水平是否应该用来区分单纯性和穿孔性阑尾炎。结果：穿孔性阑尾炎患儿血清胆红素中位数为27mcmoL/L，单纯性阑尾炎患儿血清胆红素中位数较低(10mmoL/L；P<0.001)。在穿孔的阑尾炎患者中，血清总胆红素的受试者工作特征(ROC)曲线下面积为0.876(95%可信区间，0.820-0.929)。ROC分析显示，当血清总胆红素(P<；0.001)的截断值为15.5mcmol/L时，灵敏度(92%)和特异度(77.3%)最佳。35例(54.7%)并发阑尾炎患者入院时出现高胆红素血症，14例(6.4%)非穿孔阑尾炎患者入院时出现高胆红素血症(P<；0.001)。多因素Logistic回归分析显示：血清胆红素浓度(OR=1.12；95%CI，1.07~1.18；P<；0.001)、血钠浓度(OR=0.64；95%CI，0.51~0.81；P<；0.001)、体温(OR=2.48；95%CI，1.05~0.84；P<；0.001)、症状持续时间(OR=1.06；95%CI，1.02~1.09；P<；0.001)是穿孔阑尾炎的危险因素。结论：血清总胆红素升高可作为儿童穿孔性阑尾炎的指标。血清胆红素水平是一种廉价、简单和可用的实验室标志物，因此应推荐在儿科急性阑尾炎的初步评估中使用。
Background: This prospective cohort study aimed to investigate the association of hyperbilirubinemia with perforated appendicitis in the pediatric population. Patients and Methods: A total of 284 children in whom the diagnosis of acute appendicitis was established were included in this study. The patients were allocated in study groups in regard to operative findings. The first study group included patients who had perforated appendicitis (n = 64; 22.5%) whereas the patients in the second group had simple appendicitis (n = 220; 77.5%). Blood samples for serum bilirubin levels and acute inflammatory markers were taken before the patients underwent surgery. The primary outcome of the study was to investigate whether the level of serum bilirubin should be used to distinguish between simple and perforated appendicitis. Results: The median level of serum bilirubin in children with perforated appendicitis was 27 mcmol/L whereas the patients with simple appendicitis had lower median levels of serum bilirubin (10 mu mol/L; p < 0.001). An area under the receiver operating characteristic (ROC) curve for total serum bilirubin was 0.876 (95% confidence interval [CI], 0.820-0.929) in the patients who had a perforated appendicitis. An ROC analysis showed the best sensitivity (92%) and specificity (77.3%) for a cutoff value of 15.5 mcmol/L for total serum bilirubin (p < 0.001). Hyperbilirubinemia at admission was found in 35 patients (54.7%) with complicated appendicitis and in 14 patients (6.4%) with non-perforated appendicitis (p < 0.001). The modeling of collected data by multivariable logistic regression identified serum bilirubin concentration (odss ratio [OR] = 1.12; 95% CI, 1.07-1.18; p < 0.001), serum sodium concentration (OR = 0.64; 95% CI, 0.51-0.81; p < 0.001), body temperature (OR = 2.48; 95% CI, 1.05-0.84; p < 0.001), and duration of symptoms (OR = 1.06; 95% CI, 1.02-1.09; p < 0.001) as risk factors for perforated appendicitis. Conclusion: Elevateds level of total serum bilirubin may be useful as an indicator of perforated appendicitis in children. Levels of bilirubin in serum is an inexpensive, simple, and available laboratory marker and should therefore be recommended in the initial evaluation for acute appendicitis in pediatric patients.