Title PREDIKTIVNA VRIJEDNOST
KONCENTRACIJE
5-HIDROKSIINDOLOCTENE KISELINE U
URINU DJECE S AKUTNOM UPALOM
CRVULJKA Title (english) PREDICTIVE VALUE OF URINARY
5-HYDROXYINDOLE ACETIC ACID LEVEL
IN DIAGNOSIS OF ACUTE APPENDICITIS
IN CHILDREN Author Ana Bosak Veršić Mentor Harry Nikolić (mentor)Committee member Mladen Peršić (predsjednik povjerenstva)Committee member Anko Antabak (član povjerenstva)Committee member Jadranka Varljen (član povjerenstva)Committee member Harry Nikolić (član povjerenstva)Granter University of Rijeka Defense date and country 2017-05-18, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 61 - Medical sciences Abstract Cilj: Akutna upala crvuljka najčešća je kirurška hitnoća u djece. Brzo postavljanje dijagnoze i
pravovremeno liječenje nužni su za sprječavanje komplikacija. Enterokromafine stanice koje
sadrže velike količine serotonina nalaze se većinom u distalnom crvuljku. Metabolit
serotonina, 5-hidroksiindoloctena kiselina koja se luči urinom, mogao bi stoga biti prediktivni
pokazatelj akutne upale crvuljka. U našem istraživanju određivali smo koncentraciju 5-
hidroksiindoloctene kiseline u urinu djece operirane zbog sumnje na akutnu upalu crvuljka te
u urinu zdrave djece. Cilj je bio utvrditi postoji li razlika u koncentracijama 5-
hidroksiindoloctene kiseline između promatranih skupina djece. Također, analizirali smo
kvalitetu Alvarado scorea te apsolutnog broja neutrofila kao prediktivnih pokazatelja akutne
upale.
Ispitanici i metode: U istraživanje je prospektivno uključeno 93 djece operirane zbog sumnje
na akutnu upalu crvuljka te 102 zdrave djece. Koncentracija 5-hidroksiindoloctene kiseline
mjerena je HPLC metodom.
Rezultati: Akutna upala crvuljka potvrđena je u 81 djeteta, a u preostalih dvanaestoro nađen
je drugi uzrok trbušne boli. Kontrolnu skupinu sačinjavalo je 102 zdrave djece. Srednje
vrijednosti 5-hidroksiindoloctene kiseline u urinu bile su 24,68±14,21 u kontrolnoj skupini,
22,52±15,96 u djece s drugim uzrokom trbušne boli i 22,98±14,84 µmol/l u djece s akutnim
apendicitisom. Statistički značajna razlika među skupinama nije nađena. Odredivši medijan
svih izmjerenih vrijednosti 5-hidroksiindoloctene kiseline kao prijelomnu vrijednost,
analizirali smo udjele pacijenata s povišenim vrijednostima po skupinama. Statistička analiza
nije pokazala značajnu razliku u raspodjeli udjela među skupinama. AUC je bila 0,55 (95 %
CI 0,47 to 0,62) s osjetljivošću i specifičnošću 60,4 % i 48,9 %. Nadalje, u djece s akutnom
upalom crvuljka vrijednosti apsolutnog broja neutrofila bile su značajno povišene u odnosu na
djecu s drugim uzrokom trbušne boli, a koja su operativno liječena. Također, Alvarado score
veći od 8 pokazao se indikativnim za akutnu upalu crvuljka.
Zaključak: Povišena koncentracija 5-hidroksiindoloctene kiseline u urinu nema prediktivnu
vrijednost u akutnoj upali crvuljka. Više vrijednosti apsolutnog broja neutrofila ukazuju na
progresiju procesa upale. Alvarado score pouzdan je prediktivni pokazatelj akutne upale
crvuljka.
Abstract (english) Aim: Acute appendicitis is the most common surgical emergency in children. Prompt
diagnosis and surgical treatment are required to prevent complications. Enterochromaffin
cells that contain large amounts of serotonin are mostly located in the distal appendix.
Serotonin metabolite 5-hydroxyindoleacetic acid that is excreted in urine could therefore be a
marker for acute appendicitis. We tested urinary 5-hydroxyindoleacetic acid concentrations in
spot urine samples of children operated for the suspicion of acute appendicitis and in urine
samples of healthy children to establish whether there was a difference in concentrations
among the observed groups. Furthermore, we analysed the quality of Alvarado score and
absolute neutrophil count as the predictors of acute appendicitis.
Materials and methods: We enrolled 93 patients who underwent surgery for the suspicion of
acute appendicitis and 102 healthy children. Their 5-hydroxyindoleacetic acid was measured
using HPLC.
Results: Acute appendicitis was confirmed in 81 children, whereas there were other
explanations for abdominal pain in the remaining 12 patients in the non-appendicitis group.
The control group comprised 102 healthy children. Mean levels of 5-hydroxyindoleacetic acid
were 24.68±14.21 in the control group, 22.52±15.96 in the non-appendicitis group and
22.98±14.84 µmol/l in children with acute appendicitis. Taking the median of all measured 5-
hidroxyindoleacetic acid values as a cut-off, we analysed the proportions of patients with
elevated values among the groups. Statically significant difference was not shown. AUC was
0.55 (95 % CI 0.47 to 0.62) with sensitivity and specificity of 60.4 % and 48.9 %,
respectively. In children with acute appendicitis the absolute neutrophil count values were
significantly elevated when compared to those with another cause of abdominal pain.
Alvarado score higher than 8 was identified as a good predictor of acute appendicitis.
Conclusion: Urine 5-hydroxyindoleacetic acid concentration measured in spot samples is not
a reliable method for diagnosing acute appendicitis in children. Higher values of absolute
neutrophil count suggest there is a progression of the inflammatory process in the vermiform
appendix. Alvarado score is a good predictor of acute appendicitis.
Keywords
Akutna upala crvuljka
Bodovni sustav
Dijete
Hidroksiindoloctena kiselina
Urin.
Keywords (english)
Appendicitis
Child
Hydroxyindoleacetic acid
Scoring System
Urine
Language croatian URN:NBN urn:nbn:hr:184:250001 Study programme Title: Biomedicine Postgraduate (doctoral) study programme Type of resource Text File origin Born digital Access conditions Access restricted to students and staff of home institution Terms of use Created on 2022-03-16 17:57:30
