Neutrophil myeloperoxidase index in pediatric acute appendicitis

Nikola D Stanković; Dragan Đorđević; Goran Rondović; Zoran Kostić; Snježana Zeba; Snežana Milosavljević; Đorđe Savić; Maja Miličković; Blagoje Grujić; Slaviša Đuričić; Ivan Stanojevic; Marijana  Milanović

doi:10.2298/VSP171218012S

Nikola D Stanković Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić“, Department of Anesthesiology and Intensive Therapy, Belgrade, Serbia
Dragan Đorđević Military Medical Academy, Clinic of Anesthesiology and Intensive Therapy, Belgrade, Serbia;
Goran Rondović Military Medical Academy, Clinic of Anesthesiology and Intensive Therapy, Belgrade, Serbia;
Zoran Kostić University of Defence,Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Snježana Zeba Military Medical Academy, Clinic of Anesthesiology and Intensive Therapy, Belgrade, Serbia;
Snežana Milosavljević Clinical Hospital Center, Department of Anesthesiology, Kosovska Mitrovica, Serbia
Đorđe Savić Clinical Hospital Center, Department of Anesthesiology, Kosovska Mitrovica, Serbia
Maja Miličković Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić“, Department of Abdominal Surgery, Belgrade, Serbia
Blagoje Grujić Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić“, Department of Abdominal Surgery, Belgrade, Serbia
Slaviša Đuričić Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić“, Department of Clinical Pathology, Belgrade, Serbia
Ivan Stanojevic Military Medical Academy, Institute for Medical Research, Belgrade, Serbia
Marijana Milanović Military Medical Academy, Institute for Medical Research, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP171218012S

Keywords: appendicitis, appendectomy, child, diagnosis, differential, peroxidase, neutrophils, c-reactive protein, interleukin-6

Abstract

Abstract

Background/Aim. Diagnosis of acute appendicitis (AA) remains the most common dilemma of pediatric surgical team. Our aim was to determine whether the neutrophil myeloperoxidase index (MPXI), in combination with other laboratory and clinical parameters, can be useful in diagnosis and follow-up of AA in children. Methods. A prospective investigation of MPXI values in 117 consecutive patients, planned for the surgical intervention due to AA, was performed. The patients were stratified into three groups according to the intraoperative finding: the normal/early, uncomplicated and complicated AA. Laboratory analyses were done preoperativly, on the 1st and on the 3rd postoperative days. Results. The statistically significant difference of MPXI values between the uncomplicated and complicated appendicitis before surgery and the positive correlations between the MPXI and C-reactive protein, as well as interleukin-6, before surgery were found. Postoperatively, in the group of uncomplicated, as well as complicated AA, a significant decrease of MPXI was recorded. Conclusion. The MPXI may be used as an informative biomarker in the follow-up of AA in children. A wide reference range for the MPXI and individual differences in the values of MPXI in the healthy children, generate difficulties for its use for the initial diagnosis of acute appendicitis. Usefulness of MPXI determination decreases with a delayed diagnosis.

Author Biography

Nikola D Stanković, Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić“, Department of Anesthesiology and Intensive Therapy, Belgrade, Serbia

Asist mr sci. med.

References

REFERENCES

Cheong LH, Emil S. Outcomes of Pediatric AppendicitisAn In-ternational Comparison of the United States and Canada. JA-MA Surg 2014; 149(1): 50–5.

Flum DR, Morris A, Koepsell T, Dellinger EP. Has Misdiagnosis of Appendicitis Decreased Over Time? A population-based analysis. JAMA 2001; 286(14): 1748–53.

Mariadason J, Wang W, Wallack M, Belmonte A, Matari H. Negative appendicectomy rate as a quality metric in the management of appendicitis: impact of computed tomography, Alvarado score and the definition of negative appendicectomy. Ann R Coll Surg Engl 2012; 94(6): 395–401.

Larsson PG, Henriksson G, Olsson M, Boris J, Ströberg P, Tronstad SE, et al. Laparoscopy reduces unnecessary appendicectomies and improves diagnosis in fertile women: A randomized study. Surg Endosc 2001; 15(2): 200–2.

Livingston EH, Woodward WA, Sarosi GA, Haley RW. Discon-nect Between Incidence of Nonperforated and Perforated Ap-pendicitis: implications for pathophysiology and management. Ann Surg 2007; 245(6): 886–92.

Velanovich V, Satava R. Balancing the normal appendectomy rate with the perforated appendicitis rate: Implications for quality assurance. Am Surg 1992 58(4): 264-9.

Bononi A, Lanza F, Dabusti M, Gusella M, Gilli G, Menon D, et al. Increased myeloperoxidase index and large unstained cell values can predict the neutropenia phase of cancer patients treated with standard dose chemotherapy. Cytometry 2001; 46(2): 92–7.

Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 2015; 386(10000): 1278–87.

Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC. Sys-tematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg 2013; 100(3): 322–9.

Andersson M, Rubér M, Ekerfelt C, Hallgren HB, Olaison G, An-dersson RE. Can New Inflammatory Markers Improve the Di-agnosis of Acute Appendicitis? World J Surg 2014; 38(11): 2777–83.

Hampton MB, Kettle AJ, Winterbourn CC. Inside the Neutrophil Phagosome: Oxidants, Myeloperoxidase, and Bacterial Killing. Blood 1998; 92(9): 3007–17.

Klebanoff SJ. Myeloperoxidase: friend and foe. J Leukoc Biol 2005; 77(5): 598–625.

Dale DC, Boxer L, Liles WC. The phagocytes: neutrophils and monocytes. Blood 2008; 112(4): 935–45.

Krause JR, Costello RT, Krause J, Penchansky L. Use of the Tech-nicon H-1 in the characterization of leukemias. Arch Pathol Lab Med 1988; 112(9): 889–94.

Ross DW, Bentley SA. Evaluation of an automated hematology system (Technicon H-1). Arch Pathol Lab Med 1986; 110: 803–8.

Gulley ML, Bentley SA, Ross DW. Neutrophil myeloperoxidase measurement uncovers masked megaloblastic anemia. Blood 1990; 76(5): 1004–7.

Eivazi-Ziaei J, Dastgiri S, Sanaat ZR. Estimation of the diagnostic value of myeloperoxidase index and lactate dehydrogenase in megaloblastic anemia. J Clin Diagn Res 2007; 1: 380–4.

Yonezawa K, Horie O, Yoshioka A, Matsuki S, Tenjin T, Tsukamu-ra Y, et al. Association between the neutrophil myeloperox-idase index and subsets of bacterial infections. Int J Lab He-matol 2010; 32(6 Pt 2): 598–605.

Yonezawa K, Morimoto N, Matsui K, Tenjin T, Yoneda M, Emoto T, et al. Significance of the Neutrophil Myeloperoxidase Index in Patients with Atherosclerotic Diseases. Kobe J Med Sci 2013; 58(5): E128–37.

Kim OH, Cha YS, Hwang SO, Jang JY, Choi EH, Kim HI, et al. The Use of Delta Neutrophil Index and Myeloperoxidase In-dex for Predicting Acute Complicated Appendicitis in Child-ren. PLoS ONE 2016; 11(2): e0148799.

Samuel M. Pediatric appendicitis score. J Pediatr Surg 2002; 37(6): 877–81.

Stankovic N, Stanojevic I, Djordjevic D, Kostic Z, Udovicic I, Milickovic M, et al. Neutrophil-to-lymphocyte ratio in pediatric acute appendicitis. Vojnosanit Pregl 2018; 75(1): 46–55.

Kwan KY, Nager AL. Diagnosing pediatric appendicitis: useful-ness of laboratory markers. Am J Emerg Med 2010; 28(9): 1009–15.

Black S, Kushner I, Samols D. C-reactive Protein. J Biol Chem 2004; 279(47): 48487–90.

Rubér M, Andersson M, Petersson BF, Olaison G, Andersson RE, Ekerfelt C. Systemic Th17-like cytokine pattern in gangrenous appendicitis but not in phlegmonous appendicitis. Surgery 2010; 147(3): 366–72.

Odobasic D, Kitching AR, Holdsworth SR. Neutrophil-Mediated Regulation of Innate and Adaptive Immunity: The Role of Myeloperoxidase. J Immunol Res 2016; 2016: 2349817.