Pediatric surgery international · 2025
The predictive value of neutrophil, C-reactive protein, fibrinogen, and chloride for acute complicated appendicitis in children: a multicenter retrospective study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Ding Xiaoting, Li Yongteng, Yu Daiyue, Huang Qiwei, Wang ShaoMei, Bai Jian, Pan Yongbin, Adam Mahamat Djibril, Yang Liucheng, Wu Kai
Аннотация
OBJECTIVES: This study aimed to develop a diagnostic model utilizing clinical and laboratory data to identify complicated appendicitis in pediatric patients, improving acute appendicitis management.
METHODS: Retrospective analysis of pediatric acute appendicitis cases (2018-2023) at two hospitals collected medical history, clinical criteria, and blood samples. Patients were divided into complicated and uncomplicated appendicitis groups for comparison. Significant variables were identified using the Least Absolute Shrinkage and Selection Operator (LASSO), and incorporated into a logistic regression model to construct a nomogram. The effectiveness of the model was assessed based on sensitivity, specificity, accuracy, and comparison with existing scoring systems.
RESULTS: Among 323 patients, four variables (neutrophil (NEU), C-reactive protein (CRP), fibrinogen (Fg), and chlorine (Cl)) were identified as significant. The recommended cutoff value of nomogram was 0.730, exceeding that of Alvarado and PAS, with higher sensitivity (81.7%), specificity (82.6%), and accuracy (82.0%), as well as better performance in both internal and external validations. Furthermore, it demonstrated excellent calibration and clinical utility.
CONCLUSIONS: NEU, CRP, Fg, and Cl are effective markers for diagnosing complicated appendicitis in children. The nomogram model can be considered to be incorporated into the diagnosis process of appendicitis as an auxiliary means of surgical intervention decision-making in complex appendicitis cases.
METHODS: Retrospective analysis of pediatric acute appendicitis cases (2018-2023) at two hospitals collected medical history, clinical criteria, and blood samples. Patients were divided into complicated and uncomplicated appendicitis groups for comparison. Significant variables were identified using the Least Absolute Shrinkage and Selection Operator (LASSO), and incorporated into a logistic regression model to construct a nomogram. The effectiveness of the model was assessed based on sensitivity, specificity, accuracy, and comparison with existing scoring systems.
RESULTS: Among 323 patients, four variables (neutrophil (NEU), C-reactive protein (CRP), fibrinogen (Fg), and chlorine (Cl)) were identified as significant. The recommended cutoff value of nomogram was 0.730, exceeding that of Alvarado and PAS, with higher sensitivity (81.7%), specificity (82.6%), and accuracy (82.0%), as well as better performance in both internal and external validations. Furthermore, it demonstrated excellent calibration and clinical utility.
CONCLUSIONS: NEU, CRP, Fg, and Cl are effective markers for diagnosing complicated appendicitis in children. The nomogram model can be considered to be incorporated into the diagnosis process of appendicitis as an auxiliary means of surgical intervention decision-making in complex appendicitis cases.