The value of interleukin-6 in predicting acute appendicitis in children and distinguishing complicated appendicitis: a systematic review and meta-analysis.

OBJECTIVES

The identification of new, easily measurable biomarkers may assist clinicians in diagnosing and managing acute appendicitis. Although inflammatory markers have been applied in pediatric appendicitis diagnosis, the diagnostic and disease assessment value of interleukin-6 (IL-6) as a key inflammatory factor in this condition has not yet been systematically evaluated.

METHODS

We conducted a systematic search of electronic databases to identify all studies reporting IL-6 in children with a clinical diagnosis of acute appendicitis. We considered two comparisons: 1) appendicitis versus no appendicitis and 2) uncomplicated appendicitis (UA) versus complicated appendicitis (CA). We converted and analyzed the odds ratios from the multivariate analysis to determine the independent predictive value of IL-6 in pediatric acute appendicitis.

RESULTS

Seventeen studies were included in this meta-analysis. These studies enrolled a total of 3,104 patients. The IL-6 levels were significantly higher in patients with acute appendicitis (MD -19.99; 95% CI: -31.19 to -8.79; p = 0.0008; I2 = 73.8%). The levels of IL-6 were statistically significantly higher in the CA group (MD -95.75; 95% CI: -151.86 to -39.65; p < 0.0001; I2 = 86%). IL-6 may not be an independent predictor of CA in children (OR: 0.94; 95% CI: 0.75 to 1.18; I2 = 86%). Subgroup analysis and sensitivity analysis suggested that the diagnostic performance of IL-6 was not significantly modified by the detection method.

CONCLUSION

IL-6 may serve as one of the markers for distinguishing UA from CA, although no clear association was found regarding its independent predictive value. Future prospective studies with larger sample sizes are warranted to establish higher-level evidence.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier PROSPERO CRD420251234189.