Serum and peritoneal inflammatory mediators in children with suspected acute appendicitis.
OBJECTIVE
Inflammatory markers differ between subjects with appendicitis and controls. Markers of inflammation differ in serum compared with intraperitoneal fluid. Among subjects with appendicitis, inflammatory markers differ between subjects with and without perforation.


METHODS
Cross-sectional.


METHODS
Hospitalized care.


METHODS
Twenty-four children who underwent an appendectomy. Group A (n = 19) consisted of patients with appendicitis and group N (n = 5) of patients with normal appendixes.


METHODS
Serum and peritoneal levels of interleukin (IL)8, IL-10, granulocyte colony-stimulating factor, interferon gamma soluble intercellular adhesion molecule-1, matrix metalloproteinase-9, and tissue inhibitor of metalloproteinases-1 were measured by enzyme-linked immunosorbent assay.


RESULTS
Age, sex, complete blood count, C-reactive protein level, and serum cytokines did not significantly differ by group. Peritoneal concentrations of interleukin-8 (mean +/- SD, 1416.8 +/- 1436 pg/mL vs 48 +/- 74.4 pg/mL, P = .001), IL-10 (mean +/- SD, 3085 +/- 5893 pg/mL vs 84 +/- 46 pg/mL, P = .02), matrix metalloproteinase-9 (mean +/- SD, 1784 +/- 1225.1 ng/mL vs 435 +/- 563 ng/mL, P = .03), and tissue inhibitor of metalloproteinases-1 (mean +/- SD, 8939.2 +/- 7312.2 ng/mL vs 602.1 +/- 345.6 ng/mL, P<.001) were significantly different in group A compared with group N. When compared by perforation (n = 8 with perforation vs n = 11 without perforation), peritoneal granulocyte colony-stimulating factor levels were elevated in subjects with perforation (mean +/- SD, 4.3 +/- 14.4 pg/mL vs 62.7 +/- 79.2 pg/mL, P = .02). Although serum tissue inhibitor of metalloproteinases-1 was not different between groups N and A, it was significantly different between group N and patients with a perforated appendicitis (mean +/- SD, 205.9 +/- 43.8 ng/mL vs 3068.9 +/- 5122.4 ng/mL, P = .04).


CONCLUSIONS
Presently, it is not practical to differentiate appendicitis in a pediatric population from other causes of abdominal pain based on the detection of systemic inflammatory response markers.
Dalal
Ilan
I
Pediatric Infectious/Allergy/Immunology Unit, The E. Wolfson Medical Center, Holon, Israel.
Somekh
Eli
E
Bilker-Reich
Avital
A
Boaz
Mona
M
Gorenstein
Arkadi
A
Serour
Francis
F
D015746:Abdominal Pain / Q000175:diagnosis; D000208:Acute Disease; D001064:Appendicitis / Q000175:diagnosis*; D001202:Ascitic Fluid / Q000737:chemistry*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000032:analysis; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis* / Q000097:blood; D007378:Interleukins / Q000032:analysis; D008297:Male; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000032:analysis
D018836:Inflammation Mediators; D007378:Interleukins; D019715:Tissue Inhibitor of Metalloproteinase-1; D016179:Granulocyte Colony-Stimulating Factor