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Eur J Pediatr Surg 2014; 24(02): 179-183
DOI: 10.1055/s-0033-1347295
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Are Neutrophil CD64 Expression and Interleukin-6 Early Useful Markers for Diagnosis of Acute Appendicitis?

İsmet F. Ozguner
1   Department of Pediatric Surgery, Dr Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey
,
Murat Kızılgun
2   Department of Biochemistry, Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey
,
Ayse Karaman
1   Department of Pediatric Surgery, Dr Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey
,
Yusuf Hakan Cavusoğlu
1   Department of Pediatric Surgery, Dr Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey
,
Derya Erdoğan
1   Department of Pediatric Surgery, Dr Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey
,
İbrahim Karaman
1   Department of Pediatric Surgery, Dr Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey
,
Çağatay Evrim Afşarlar
1   Department of Pediatric Surgery, Dr Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey
,
Engin Yılmaz
1   Department of Pediatric Surgery, Dr Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey
› Institutsangaben
Weitere Informationen

Publikationsverlauf

03. Januar 2013

11. April 2013

Publikationsdatum:
11. Juni 2013 (online)

Auch verfügbar auf
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Abstract

Background/Purpose The aim of the study is to evaluate the diagnostic value of interleukin-6 (IL-6) level and neutrophil cluster of differentiation 64 (CD64) expression in diagnosis of acute appendicitis (AA).

Methods A prospective controlled trail was performed. Children who were hospitalized with a diagnosis of right lower quadrant pain were our cohort. Serum samples for white blood cell, C-reactive protein (CRP), leukocyte CD64 expression, and IL-6 were obtained from the patients just after their admission. Operation was performed if appendicitis seemed probable, others were observed actively. Patients who had noncomplicated appendicitis were Group 1, patients who had complicated appendicitis were Group 2, and patients who had discharged after observation without operation with a diagnosis of nonspecific abdominal pain and had negative appendectomy without another surgical disease were Group 3.

Results In this study, 49 patients were enrolled. CRP and CD64 levels were found higher in Group 2. IL-6 levels were found to be lower in Group 3 than Groups 1 and 2.

Conclusions There was a difference between Group 2 and the other groups about CD64 levels. The CRP level and expression of leukocyte CD64 level did not effectively predict the diagnosis of noncomplicated appendicitis, but it predicted well the patients with complicated appendicitis. However, IL-6 levels are statistically significantly different between Group 3 and Groups 1 and 2. According to this result, IL-6 levels predicted well the patient with appendicitis. Applying additional diagnostic methods such as IL-6 levels seems to be helpful in reducing the numbers of false-positive diagnosis of AA.

Keywords

appendicitis - interleukin-6 - CD64 antigens - C-reactive protein - child
 

  • References

  • 1 Simpson J, Scholefield JH. Acute appendicitis. Surgery 2002; 20 (7) 153-157
    PubMedGoogle Scholar
  • 2 Groselj-Grenc M, Repse S, Vidmar D, Derganc M. Clinical and laboratory methods in diagnosis of acute appendicitis in children. Croat Med J 2007; 48 (3) 353-361
    PubMedGoogle Scholar
  • 3 Lessin MS, Chan M, Catallozzi M , et al. Selective use of ultrasonography for acute appendicitis in children. Am J Surg 1999; 177 (3) 193-196
    CrossrefPubMedGoogle Scholar
  • 4 Cavuşoğlu YH, Erdoğan D, Karaman A, Aslan MK, Karaman I, Tütün OC. Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis. Pediatr Surg Int 2009; 25 (3) 277-282
    CrossrefPubMedGoogle Scholar
  • 5 Paajanen H, Mansikka A, Laato M, Kettunen J, Kostiainen S. Are serum inflammatory markers age dependent in acute appendicitis?. J Am Coll Surg 1997; 184 (3) 303-308
    PubMedGoogle Scholar
  • 6 Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J 1990; 265 (3) 621-636
    PubMedGoogle Scholar
  • 7 Amalesh T, Shankar M, Shankar R. CRP in acute appendicitis—is it a necessary investigation?. Int J Surg 2004; 2 (2) 88-89
    CrossrefPubMedGoogle Scholar
  • 8 Khan MN, Davie E, Irshad K. The role of white cell count and C-reactive protein in the diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 2004; 16 (3) 17-19
    PubMedGoogle Scholar
  • 9 Zimmerman MA, Selzman CH, Cothren C, Sorensen AC, Raeburn CD, Harken AH. Diagnostic implications of C-reactive protein. Arch Surg 2003; 138 (2) 220-224
    CrossrefPubMedGoogle Scholar
  • 10 Sengupta A, Bax G, Paterson-Brown S. White cell count and C-reactive protein measurement in patients with possible appendicitis. Ann R Coll Surg Engl 2009; 91 (2) 113-115
    CrossrefPubMedGoogle Scholar
  • 11 Schiff DE, Rae J, Martin TR, Davis BH, Curnutte JT. Increased phagocyte Fc gammaRI expression and improved Fc gamma-receptor-mediated phagocytosis after in vivo recombinant human interferon-gamma treatment of normal human subjects. Blood 1997; 90 (8) 3187-3194
    PubMedGoogle Scholar
  • 12 Davis B, Wallace P, Guyre P. Pathophysiology of human Fc-gamma receptors in health and disease. In: Robinson JP, Babcock GF, , eds. Phagocyte Function: A Guide for Research and Clinical Evaluation. New York: Wiley-Liss; 1998: 47-76
    Google Scholar
  • 13 Qureshi SS, Lewis SM, Gant VA, Treacher D, Davis BH, Brown KA. Increased distribution and expression of CD64 on blood polymorphonuclear cells from patients with the systemic inflammatory response syndrome (SIRS). Clin Exp Immunol 2001; 125 (2) 258-265
    CrossrefPubMedGoogle Scholar
  • 14 Simms HH, Frank MM, Quinn TC, Holland S, Gaither TA. Studies on phagocytosis in patients with acute bacterial infections. J Clin Invest 1989; 83 (1) 252-260
    CrossrefPubMedGoogle Scholar
  • 15 Guyre PM, Campbell AS, Kniffin WD, Fanger MW. Monocytes and polymorphonuclear neutrophils of patients with streptococcal pharyngitis express increased numbers of type I IgG Fc receptors. J Clin Invest 1990; 86 (6) 1892-1896
    CrossrefPubMedGoogle Scholar
  • 16 Herra CM, Keane CT, Whelan A. Increased expression of Fc gamma receptors on neutrophils and monocytes may reflect ongoing bacterial infection. J Med Microbiol 1996; 44 (2) 135-140
    CrossrefPubMedGoogle Scholar
  • 17 Leino L, Sorvajärvi K, Katajisto J , et al. Febrile infection changes the expression of IgG Fc receptors and complement receptors in human neutrophils in vivo. Clin Exp Immunol 1997; 107 (1) 37-43
    CrossrefPubMedGoogle Scholar
  • 18 Ng PC, Li G, Chui KM , et al. Neutrophil CD64 is a sensitive diagnostic marker for early-onset neonatal infection. Pediatr Res 2004; 56 (5) 796-803
    CrossrefPubMedGoogle Scholar
  • 19 Ng PC, Li K, Wong RP, Chui KM, Wong E, Fok TF. Neutrophil CD64 expression: a sensitive diagnostic marker for late-onset nosocomial infection in very low birthweight infants. Pediatr Res 2002; 51 (3) 296-303
    CrossrefPubMedGoogle Scholar
  • 20 Wagner C, Deppisch R, Denefleh B, Hug F, Andrassy K, Hänsch GM. Expression patterns of the lipopolysaccharide receptor CD14, and the FCgamma receptors CD16 and CD64 on polymorphonuclear neutrophils: data from patients with severe bacterial infections and lipopolysaccharide-exposed cells. Shock 2003; 19 (1) 5-12
    PubMedGoogle Scholar
  • 21 Allen E, Bakke AC, Purtzer MZ, Deodhar A. Neutrophil CD64 expression: distinguishing acute inflammatory autoimmune disease from systemic infections. Ann Rheum Dis 2002; 61 (6) 522-525
    CrossrefPubMedGoogle Scholar
  • 22 Moallem HJ, Kalayci O, Homel P , et al. Expression of Fc(gamma)r1 (CD64) on polymorphonuclear leucocytes during progression to acquired immunodeficiency syndrome in perinatally human immunodeficiency virus-infected children. Scand J Immunol 2000; 52 (2) 184-189
    CrossrefPubMedGoogle Scholar
  • 23 Layseca-Espinosa E, Pérez-González LF, Torres-Montes A , et al. Expression of CD64 as a potential marker of neonatal sepsis. Pediatr Allergy Immunol 2002; 13 (5) 319-327
    Google Scholar
  • 24 Asfar S, Safar H, Khoursheed M, Dashti H, al-Bader A. Would measurement of C-reactive protein reduce the rate of negative exploration for acute appendicitis?. J R Coll Surg Edinb 2000; 45 (1) 21-24
    PubMedGoogle Scholar
  • 25 Gurleyik E, Gurleyik G, Unalmişer S. Accuracy of serum C-reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression. Dis Colon Rectum 1995; 38 (12) 1270-1274
    CrossrefPubMedGoogle Scholar
  • 26 Eriksson S, Olander B, Pira U, Granström L. White blood cell count, leucocyte elastase activity, and serum concentrations of interleukin-6 and C-reactive protein after open appendicectomy. Eur J Surg 1997; 163 (2) 123-127
    PubMedGoogle Scholar
  • 27 Grönroos JM, Grönroos P. Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg 1999; 86 (4) 501-504
    CrossrefPubMedGoogle Scholar
  • 28 Kharbanda AB, Cosme Y, Liu K, Spitalnik SL, Dayan PS. Discriminative accuracy of novel and traditional biomarkers in children with suspected appendicitis adjusted for duration of abdominal pain. Acad Emerg Med 2011; 18 (6) 567-574
    CrossrefPubMedGoogle Scholar
  • 29 Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology 1986; 158 (2) 355-360
    CrossrefPubMedGoogle Scholar
  • 30 Almagor M, Mintz A, Sibirsky O, Durst A. Preoperative and postoperative levels of interleukin-6 in patients with acute appendicitis: comparison between open and laparoscopic appendectomy. Surg Endosc 2005; 19 (3) 331-333
    CrossrefPubMedGoogle Scholar
  • 31 Gürleyik G, Gürleyik E, Cetinkaya F, Unalmiser S. Serum interleukin-6 measurement in the diagnosis of acute appendicitis. ANZ J Surg 2002; 72 (9) 665-667
    CrossrefPubMedGoogle Scholar
  • 32 Ballot DE, Perovic O, Galpin J, Cooper PA. Serum procalcitonin as an early marker of neonatal sepsis. S Afr Med J 2004; 94 (10) 851-854
    PubMedGoogle Scholar
  • 33 Neely AN, Fowler LA, Kagan RJ, Warden GD. Procalcitonin in pediatric burn patients: an early indicator of sepsis?. J Burn Care Rehabil 2004; 25 (1) 76-80
    CrossrefPubMedGoogle Scholar
  • 34 Szakmany T, Molnar Z. Procalcitonin levels do not predict mortality following major abdominal surgery. Can J Anaesth 2003; 50 (10) 1082-1083
    CrossrefPubMedGoogle Scholar
  • 35 Banez EI. Hematologic response to acute inflammation: the band neutrophil revisited. Tex Med 1990; 86 (4) 26-28
    PubMedGoogle Scholar
  • 36 Bentley SA. Alternatives to the neutrophil band count. Arch Pathol Lab Med 1988; 112 (9) 883-884
    PubMedGoogle Scholar
  • 37 Seebach JD, Morant R, Rüegg R, Seifert B, Fehr J. The diagnostic value of the neutrophil left shift in predicting inflammatory and infectious disease. Am J Clin Pathol 1997; 107 (5) 582-591
    PubMedGoogle Scholar
  • 38 Coleman C, Thompson Jr JE, Bennion RS, Schmit PJ. White blood cell count is a poor predictor of severity of disease in the diagnosis of appendicitis. Am Surg 1998; 64 (10) 983-985
    PubMedGoogle Scholar
  • 39 Cornbleet PJ. Clinical utility of the band count. Clin Lab Med 2002; 22 (1) 101-136
    CrossrefPubMedGoogle Scholar