Diagnostic performance of serum interleukin-6 in pediatric acute appendicitis:a systematic review

Background Despite the radiological and analytical advances of the last decades,there is still a significant rate of diagnostic error in pediatric acute appendicitis.In recent years,multiple biomarkers have emerged as potential diagnostic tools.This study aimed to examine the diagnostic performance of serum interleukin-6 in pediatric acute appendicitis.Methods 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.Results The research in the medical bibliography databases resulted in 68 articles.We removed 26 duplicates.Among the remaining 42 articles,we excluded 33 following the inclusion and exclusion criteria.Of the final 9 studies included in this review,8 provided measured serum interleukin-6 values,and all of them reported significant differences between groups,but inconsistent results regarding sensitivity and specificity.Conclusions The diagnostic performance of interleukine-6 alone for the diagnosis of acute appendicitis in children is limited.The sensitivity and specificity of interleukine-6 for the diagnosis of non-complicated acute appendicitis in the pediatric population are moderate but increased in complicated appendicitis.There seems to be a direct relationship between serum level of interleukin-6 and the hours of evolution of abdominal pain in children with acute appendicitis.The increasingly widespread use of non-operative management of acute appendicitis warrants further exploration of the classificatory potential of this marker between complicated and uncomplicated appendicitis.We consider that this may be an avenue of research to explore in the future.

Discriminatory capacity of serum interleukin-6 between complicated and uncomplicated acute appendicitis in children:a prospective validation study

Background Serum interleukin-6(IL-6)has a moderate diagnostic performance in pediatric acute appendicitis(PAA).The evidence regarding its capacity to discern between complicated and uncomplicated PAA is scarce.Methods We designed a prospective observational study to validate serum IL-6 as a marker for diagnostic classification between complicated and uncomplicated PAA.This study included 205 patients divided into three groups:(1)patients who underwent major outpatient surgery(n=57);(2)patients with non-surgical abdominal pain(NSAP)in whom the diagnosis of PAA was excluded(n=53),and(3)patients with a confirmed diagnosis of PAA(n=95).The PAA patients were further classified as uncomplicated or complicated PAA.IL-6 concentration was determined in all patients at diagnosis.Comparative statistical analysis was performed using the Mann-Whitney U test,the Fisher exact test and the Kruskall Wallis test.The area under the receiver operating characteristic curves(AUC)were calculated.Results Median(interquartile range,IQR)serum IL-6 values were 2 pg/mL(2.0–3.4)in group 1,3.9 pg/mL(2.4–11.9)in group 2,and 23.9 pg/mL(11.1–61.0)in group 3(P<0.001).Among the participants in group 3,those with uncomplicated PAA had median(IQR)serum IL-6 values of 17.2 pg/mL(8.5–36.8),and those with complicated PAA had 60.25 pg/mL(27.1–169)serum IL-6(P<0.001).At the cut-off point of 19.55 pg/mL,the AUC for the discrimination between patients in group 2 vs.3 was 0.83[95%confidence interval(CI)0.76–0.90],with a sensitivity of 61.3%and a specificity of 86.8.The AUC for the discrimination between patients with uncomplicated and complicated PAA was 0.77(95%CI 0.68–0.86)and the cut-off point was 25.90 pg/mL,with a sensitivity and specificity of 84.6%and 65.6%,respectively.Conclusions Serum IL-6 has a good performance in discerning between complicated and uncomplicated PAA.A score including clinical and radiological variables may increase the diagnostic performance of this molecule.