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Arredondo Montero J, Bueso Asfura OE, Pérez Riveros BP, López Burgos E, Rico Jiménez M. Diagnostic performance of urinary 5-Hydroxyindoleacetic Acid in acute appendicitis: a systematic review and diagnostic test accuracy meta-analysis. Int J Colorectal Dis 2023; 38:269. [PMID: 37982905 DOI: 10.1007/s00384-023-04556-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES This study aimed to analyze the diagnostic performance of urinary 5-Hydroxyindoleacetic Acid (5-HIAA) in acute appendicitis (AA). METHODS This review was registered in PROSPERO (CRD42023399541). We included prospective or retrospective original clinical studies evaluating the diagnostic performance of 5-HIAA in AA. A search was conducted in PubMed, Web of Science, Scopus and OVID. Search terms and keywords were: (appendicitis OR acute appendicitis) AND (5-HIAA OR 5-Hydroxyindoleacetic acid OR serotonin metabolite). Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS2 index. A synthesis of the results, standardization of the metrics, and a random-effect meta-analysis were performed. Additionally, a coupled forest plot and a diagnostic test accuracy meta-analysis (DTA) were performed. RESULTS Twelve studies with data from 1467 participants (724 patients with a confirmed diagnosis of AA and 743 controls) were included in this review. The random-effect meta-analysis of urinary 5-HIAA (AA vs controls) included 7 articles (352 AA and 258 controls) and resulted in a significant mean difference [95% CI] of 23.30 [15.82-30.77] μmol/L (p < 0.001). The DTA meta-analysis of urinary 5-HIAA included 8 articles and resulted in a pooled sensitivity [95% CI] of 68.6 [44.1-85.9]% and a pooled specificity [95% CI] of 82 [54.7-94.5]%. CONCLUSIONS Although the evidence is heterogeneous and limited, urinary 5-HIAA emerges as a potential non-invasive diagnostic tool for AA. Urinary 5-HIAA does not seem to be a useful biomarker to distinguish between NCAA and CAA. Future prospective studies with a large sample size and a rigorous design are necessary to validate these findings. TRIAL REGISTRATION PROSPERO (CRD42023399541).
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Affiliation(s)
- Javier Arredondo Montero
- Pediatric Surgery Department, Complejo Asistencial Universitario de León, C/Altos de Nava S/N, 24008, León, Castilla y León, Spain.
- School of Medicine, University of Navarra, Pamplona, Navarra, Spain.
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Haji Maghsoudi L, Soltanian A, Shirzadi A, Alizadeh-Kashani R, Ahmadinejad M. Biomarker of urinary 5-HIAA as a valuable predictor of acute appendicitis. Pract Lab Med 2020; 23:e00198. [PMID: 33365378 PMCID: PMC7749426 DOI: 10.1016/j.plabm.2020.e00198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022] Open
Abstract
Background Serotonin-containing cells are abundantly found in the appendix. Studies have shown that acute appendicitis is likely to be characterized by altered urinary 5-hydroxyindole acetic acid (5-HIAA), an active serotonin metabolite. The aim of this study is to investigate the diagnostic potential of 5-HIAA as a biomarker for acute appendicitis. Method This cross-sectional study enrolled patients referred at the Madani Hospital, with right iliac fossa pain, suspected to having the acute appendicitis. Before the initiation of the basic treatment and surgery, urine samples were obtained from the patients. Enzyme-linked immunosorbent assay (ELISA) was used for the analysis of 5-HIAA urinary levels. The obtained data were statistically analyzed using SPSS v18. Results Of 129 patients included in the study with the mean age of 29 years, 62 (48.1%) were men and 67 (51.9%) were women. Appendectomy was performed in 96 patients, where 81 cases were that of acute appendicitis. The mean levels of 5-HIAA in acute appendicitis group and in the negative appendectomy group was not statistically significant. The sensitivity of the test was 54.3% based on 7.4 μmol/L as cut-off %-HIAA value. Conclusion Our study reports that 5-HIAA urine concentration is not a reliable diagnostic marker for the diagnosis of acute appendicitis.
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Affiliation(s)
- Leila Haji Maghsoudi
- Department of General Surgery, Faculty of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Soltanian
- Department of General Surgery, Faculty of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Alireza Shirzadi
- Non-Communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Reza Alizadeh-Kashani
- Department of Anesthesiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mojtaba Ahmadinejad
- Department of General Surgery, Faculty of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Discovery of Urinary Proteomic Signature for Differential Diagnosis of Acute Appendicitis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3896263. [PMID: 32337245 PMCID: PMC7165319 DOI: 10.1155/2020/3896263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/18/2019] [Indexed: 12/29/2022]
Abstract
Acute appendicitis is one of the most common acute abdomens, but the confident preoperative diagnosis is still a challenge. In order to profile noninvasive urinary biomarkers that could discriminate acute appendicitis from other acute abdomens, we carried out mass spectrometric experiments on urine samples from patients with different acute abdomens and evaluated diagnostic potential of urinary proteins with various machine-learning models. Firstly, outlier protein pools of acute appendicitis and controls were constructed using the discovery dataset (32 acute appendicitis and 41 control acute abdomens) against a reference set of 495 normal urine samples. Ten outlier proteins were then selected by feature selection algorithm and were applied in construction of machine-learning models using naïve Bayes, support vector machine, and random forest algorithms. The models were assessed in the discovery dataset by leave-one-out cross validation and were verified in the validation dataset (16 acute appendicitis and 45 control acute abdomens). Among the three models, random forest model achieved the best performance: the accuracy was 84.9% in the leave-one-out cross validation of discovery dataset and 83.6% (sensitivity: 81.2%, specificity: 84.4%) in the validation dataset. In conclusion, we developed a 10-protein diagnostic panel by the random forest model that was able to distinguish acute appendicitis from confusable acute abdomens with high specificity, which indicated the clinical application potential of noninvasive urinary markers in disease diagnosis.
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Bosak Versic A, Glavan N, Bukvic N, Tomasic Z, Nikolic H. Does elevated urinary 5-hydroxyindole acetic acid level predict acute appendicitis in children? Emerg Med J 2016; 33:848-852. [PMID: 27466348 DOI: 10.1136/emermed-2015-205559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 06/07/2016] [Accepted: 07/07/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Acute appendicitis is the most common abdominal surgical emergency in children, and appendectomy is the most frequent acute abdominal operation. Prompt diagnosis and surgical treatment are required to reduce the risk of perforation and prevent complications, especially in small children. Enterochromaffin cells that contain large amounts of serotonin are mostly located in the distal appendix. Serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) could therefore be a marker for acute appendicitis. OBJECTIVE We tested urinary 5-HIAA concentrations in spot urine samples from children with acute appendicitis. METHODS We enrolled 93 patients who underwent surgery for suspicion of acute appendicitis. The diagnosis was made intraoperatively and confirmed histopathologically. Additionally, urine samples from 102 healthy children were collected as controls. Their 5-HIAA was measured using high-performance liquid chromatography. RESULTS Acute appendicitis was diagnosed in 81 patients, 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. Considering the median of all measured 5-HIAA values as the cut-off, we analysed the proportions of patients with elevated values in all the groups. Our analysis showed that statistically there was no significant difference in the distribution of percentages among the groups. The area under the curve for 5-HIAA was 0.55 (95% CI 0.47 to 0.62) with sensitivity and specificity 60.4% and 48.9%, respectively. CONCLUSIONS Urine 5-HIAA concentration measured in spot samples is not a reliable method for diagnosing acute appendicitis in children.
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Affiliation(s)
- Ana Bosak Versic
- Pediatric Surgery Clinic, University Hospital Center Rijeka, Rijeka, Croatia
| | - Nedeljka Glavan
- Pediatric Surgery Clinic, University Hospital Center Rijeka, Rijeka, Croatia
| | - Nado Bukvic
- Pediatric Surgery Clinic, University Hospital Center Rijeka, Rijeka, Croatia
| | - Zlatko Tomasic
- Pediatric Surgery Clinic, University Hospital Center Rijeka, Rijeka, Croatia
| | - Harry Nikolic
- Pediatric Surgery Clinic, University Hospital Center Rijeka, Rijeka, Croatia
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Bakal U, Aydin S, Sarac M, Kuloglu T, Kalayci M, Artas G, Yardim M, Kazez A. Serum, Saliva, and Urine Irisin with and Without Acute Appendicitis and Abdominal Pain. BIOCHEMISTRY INSIGHTS 2016; 9:11-7. [PMID: 27330302 PMCID: PMC4910648 DOI: 10.4137/bci.s39671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/08/2016] [Accepted: 05/19/2016] [Indexed: 11/05/2022]
Abstract
A 112-amino-acid protein irisin (IRI) is widely expressed in many organs, but we currently do not know whether appendix tissue and blood cells express it. If appendix tissue and neutrophil cells express IRI, measuring its concentration in biological fluids might be helpful in the diagnosis of acute appendicitis (AA), since neutrophil cells are the currently gold-standard laboratory parameters for the diagnosis of AA. Therefore, the purpose of this study was to investigate the suitability of enzyme-linked immunosorbent assay-based measurements of the proposed myokine IRI for the discrimination of patients with AA from those with acute abdominal pain (AP) and healthy controls. Moreover, immunoreactivity to IRI was investigated in appendix tissues and blood cells. Samples were collected on admission (T1), 24 hours (T2), and 72 hours (T3) postoperatively from patients with suspected AA and from patients with AP corresponding to T1–T3, whereas control subject blood was once corresponding to T1. IRI was measured in serum, saliva, and urine by using enzyme-linked immunosorbent assay, whereas in appendix tissue and blood cells, IRI was detected by immunohistohcemistry. Appendix tissue and blood cells (except for erythrocytes) are new sources of IRI. Basal saliva, urine, and serum levels were higher in children with AA compared with postoperative levels (T2) that start to decline after surgery. This is in line with the finding that IRI levels are higher in children with AA when compared with those with AP or control subject levels, most likely due to a large infiltration of neutrophil cells in AA that release its IRI into body fluids. Measurement of IRI in children with AA parallels the increase or decrease in the neutrophil count. This new finding shows that the measurement of IRI and neutrophil count can together improve the diagnosis of AA, and it can distinguish it from AP. IRI can be a candidate marker for the diagnosis of AA and offers an additional parameter to neutrophil count. The promising receiving operating curve results indicate the following sensitivities and specificities, respectively, for IRI: serum 90% and 55%, saliva 90% and 60%, and urine 90% and 50%. Serum neutrophil count gave a sensitivity of 90% and a specificity of 90%. This promising result now needs to be confirmed in a larger group of patients.
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Affiliation(s)
- Unal Bakal
- Department of Pediatric Surgery, School of Medicine, Firat University, Elazig, Turkey
| | - Suleyman Aydin
- Department of Medical Biochemistry (Firat Hormones Research Group), School of Medicine, Firat University, Elazig, Turkey
| | - Mehmet Sarac
- Department of Pediatric Surgery, School of Medicine, Firat University, Elazig, Turkey
| | - Tuncay Kuloglu
- Department of Histology and Embryology, School of Medicine, Firat University, Elazig, Turkey
| | - Mehmet Kalayci
- Deparment of Laboratory Medical Biochemistry, Elazig Education and Research Hospital, Elazig, Turkey
| | - Gokhan Artas
- Department of Pathology, School of Medicine, Firat University, Elazig, Turkey
| | - Meltem Yardim
- Department of Medical Biochemistry (Firat Hormones Research Group), School of Medicine, Firat University, Elazig, Turkey
| | - Ahmet Kazez
- Department of Pediatric Surgery, School of Medicine, Firat University, Elazig, Turkey
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Rao A, Wilson M, Kennedy G, Mittapalli D, Tait I, Alijani A. Spot urinary 5-hydroxyindoleacetic acid is not an ideal diagnostic test for acute appendicitis. Am J Emerg Med 2016; 34:1750-3. [PMID: 27364645 DOI: 10.1016/j.ajem.2016.05.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 05/22/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND PURPOSE OF THE STUDY There is growing evidence to suggest the use of urinary 5-hydroxyindoleacetic acid (5-HIAA) test to help with the diagnosis of appendicitis. The aim of our study was to establish whether urinary 5-HIAA could be used as an effective diagnostic test for acute appendicitis. DESIGN AND METHODS A prospective double-blinded study was carried out from December 2014 to October 2015. Patients admitted to the emergency surgical ward of a teaching hospital with suspected appendicitis were included in the study. The diagnostic accuracy of the test was measured by receiver operating characteristic curve. RESULTS Ninety-seven patients were divided into 2 groups: acute appendicitis (n=38) and other diagnosis (n=59). The median value of urinary 5-HIAA was 24.19μmol/L (range, 5.39-138.27) for acute appendicitis vs 18.87μmol/L (range, 2.27-120.59) for other diagnosis group (P=.038). The sensitivity and specificity of urinary 5-HIAA at a cutoff value of 19μmol/L were 71% and 50%, respectively. Receiver operating characteristic analysis showed that the area under curve was 0.64 (confidence interval [CI], 0.513-0.737) for urinary 5-HIAA, which was lower than white blood cell count (0.69; CI, 0.574-0.797), neutrophil count (0.68; CI, 0.565-0.792), and C-reactive protein (0.76; CI, 0.657-0.857). There was no significant difference in the median values of 5-HIAA between different grades of severity of appendicitis (P=.704). CONCLUSION Urinary 5-HIAA is not an ideal test for the diagnosis of acute appendicitis.
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Affiliation(s)
- Ahsan Rao
- Department of Surgery, Ninewells Hospital and Medical School, Dundee DD2 9SY, UK.
| | - Michael Wilson
- Department of Surgery, Ninewells Hospital and Medical School, Dundee DD2 9SY, UK
| | - Gwen Kennedy
- Immunoassay Biomarker Core Laboratory, School of Medicine, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Devender Mittapalli
- Department of Surgery, Ninewells Hospital and Medical School, Dundee DD2 9SY, UK
| | - Iain Tait
- Department of Surgery, Ninewells Hospital and Medical School, Dundee DD2 9SY, UK
| | - Afshin Alijani
- Department of Surgery, Ninewells Hospital and Medical School, Dundee DD2 9SY, UK
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Bakal U, Saraç M, Ciftci H, Tartar T, Kocdemir E, Aydin S, Kazez A. Neutrophil gelatinase-associated lipocal in protein levels as an acute appendicitis biomarker in children. SPRINGERPLUS 2016; 5:193. [PMID: 27026889 PMCID: PMC4769236 DOI: 10.1186/s40064-016-1853-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 02/15/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Appendicitis is very commonly encountered in emergency clinics. There is an urgent need for early and accurate predictive biomarkers of appendicitis in order to save lives, because currently-available biomarkers are imprecise and their delayed response impairs the ability of emergency doctors and pediatric surgeons to provide timely and potentially effective therapies. This study was performed to determine whether changes in the blood levels of neutrophil gelatinase-associated lipocalin (NGAL) can help to diagnose acute appendicitis in children and distinguish acute appendicitis from abdominal pain. METHODS Sixty children were enrolled and divided into three groups, with 20 patients per group: Group 1 (patients with appendicitis), Group 2 (patients with abdominal pain) and Group 3 (control). Blood NGAL levels were determined by ELISA. RESULTS The basal average serum NGAL levels were 8.2 ng/ml for Group 1, 3.9 ng/ml for Group 2, and 3.3 ng/ml for Group 3. Twenty-four and 72 h after surgery the levels were 5.1 and 2.8 ng/ml, respectively, in Group 1, 2.9 and 2.8 ng/ml in Group 2, and 2.6, 2.7 ng/ml in Group 3. Setting the cut-off point to 7 generated an area under the receiving operating curve (ROC) curve at 95 % confidence interval with 77.3 % sensitivity and 97.4 % specificity. CONCLUSION These data indicate a significant difference in NGAL values between basal and postoperative measurements in appendicitis patients (p < 0.05). The ROC curve results showed that NGAL is a promising novel biomarker for the differential diagnosis of acute appendicitis from abdominal pain.
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Affiliation(s)
- Unal Bakal
- Department of Pediatric Surgery, School of Medicine, Firat University, 23119 Elazig, Turkey
| | - Mehmet Saraç
- Department of Pediatric Surgery, School of Medicine, Firat University, 23119 Elazig, Turkey
| | - Harun Ciftci
- Department of Medical Biochemistry, Ahievran University, 4000 Kirsehir, Turkey
| | - Tugay Tartar
- Department of Pediatric Surgery, School of Medicine, Firat University, 23119 Elazig, Turkey
| | | | - Suleyman Aydin
- Department of Medical Biochemistry and Clinical Biochemistry (Firat Hormones Research Groups), School of Medicine, Firat University, 23119 Elazig, Turkey
| | - Ahmet Kazez
- Department of Pediatric Surgery, School of Medicine, Firat University, 23119 Elazig, Turkey
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Determination of urinary 5-hydroxyindoleacetic acid by combining Dμ-SPE using carbon coated TiO2 nanotubes and LC–MS/MS. Bioanalysis 2015; 7:2857-67. [DOI: 10.4155/bio.15.205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: In this article, carbon coated titanium dioxide nanotubes (TiO2-NT@C) are employed for the determination of 5-hydroxyindole-3-acetic acid in urine by LC–MS/MS. Results: All the variables involved in the extraction have been studied and optimized in depth. The method has been analytically characterized on the basis of its linearity, accuracy, sensitivity and precision. The LOD is 155.8 μg/l while the repeatability and the reproducibility, expressed as RSD, are better than 5.42 and 5.25%, respectively. The obtained relative recovery is 115%. Conclusion: TiO2-NT@C permit the efficient extraction of 5-hydroxyindole-3-acetic acid from complex biological samples such as urine allowing its sensitive determination by LC–MS/MS.
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Bakal U, Saraç M, Ciftci H, Tartar T, Kazez A, Aydin S. Leptin and NUCB2/Nesfatin-1 in Acute Appendicitis. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ijcm.2015.612120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mills AM, Huckins DS, Kwok H, Baumann BM, Ruddy RM, Rothman RE, Schrock JW, Lovecchio F, Krief WI, Hexdall A, Caspari R, Cohen B, Lewis RJ. Diagnostic characteristics of S100A8/A9 in a multicenter study of patients with acute right lower quadrant abdominal pain. Acad Emerg Med 2012; 19:48-55. [PMID: 22221415 DOI: 10.1111/j.1553-2712.2011.01259.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Over the past decade, clinicians have become increasingly reliant on computed tomography (CT) for the evaluation of patients with suspected acute appendicitis. To limit the radiation risks and costs of CT, investigators have searched for biomarkers to aid in diagnostic decision-making. We evaluated one such biomarker, calprotectin or S100A8/A9, and determined the diagnostic performance characteristics of a developmental biomarker assay in a multicenter investigation of patients presenting with acute right lower quadrant abdominal pain. METHODS This was a prospective, double-blinded, single-arm, multicenter investigation performed in 13 emergency departments (EDs) from August 2009 to April 2010 of patients presenting with acute right lower quadrant abdominal pain. Plasma samples were tested using the investigational S100A8/A9 assay. The primary outcome of acute appendicitis was determined by histopathology for patients undergoing appendectomy or 2-week telephone follow-up for patients discharged without surgery. The sensitivity, specificity, negative likelihood ratio (LR-), and positive likelihood ratio (LR+) of the biomarker assay were calculated using the prespecified cutoff value of 14 units. A post hoc stability study was performed to investigate the potential effect of time and courier transport on the measured value of the S100A8/A9 assay test results. RESULTS Of 1,052 enrolled patients, 848 met criteria for analysis. The median age was 24.5 years (interquartile range [IQR] = 16-38 years), 57% were female, and 50% were white. There was a 27.5% prevalence of acute appendicitis. The sensitivity and specificity for the investigational S100A8/A9 assay in diagnosing acute appendicitis were estimated to be 96% (95% confidence interval [CI] = 93% to 98%) and 16% (95% CI = 13% to 19%), respectively. The LR- ratio was 0.24 (95% CI = 0.12 to 0.47), and the LR+ was 1.14 (95% CI = 1.10 to 1.19). The post hoc stability study demonstrated that in the samples that were shipped, the estimated time coefficient was 7.6 × 10(-3) ± 2.0 × 10(-3) log units/hour, representing an average increase of 43% in the measured value over 48 hours; in the samples that were not shipped, the estimated time coefficient was 2.5 × 10(-3) ± 0.4 × 10(-3) log units/hour, representing a 13% increase on average in the measured value over 48 hours, which was the maximum delay allowed by the study protocol. Thus, adjusting the cutoff value of 14 units by the magnitude of systematic inflation observed in the stability study at 48 hours would result in a new cutoff value of 20 units and a "corrected" sensitivity and specificity of 91 and 28%, respectively. CONCLUSIONS In patients presenting with acute right lower quadrant abdominal pain, we found the investigational enzyme-linked immunosorbent assay (ELISA) test for S100A8/A9 to perform with high sensitivity but very limited specificity. We found that shipping effect and delay in analysis resulted in a subsequent rise in test values, thereby increasing the sensitivity and decreasing the specificity of the test. Further investigation with hospital-based laboratory analyzers is the next critical step for determining the ultimate clinical utility of the ELISA test for S100A8/A9 in ED patients presenting with acute right lower quadrant abdominal pain.
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Affiliation(s)
- Angela M Mills
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Jangjoo A, Varasteh AR, Mehrabi Bahar M, Tayyebi Meibodi N, Esmaili H, Nazeri N, Aliakbarian M, Azizi SH. Is urinary 5-hydroxyindoleacetic acid helpful for early diagnosis of acute appendicitis? Am J Emerg Med 2011; 30:540-4. [PMID: 21450436 DOI: 10.1016/j.ajem.2011.01.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 01/11/2011] [Accepted: 01/19/2011] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Acute appendicitis is the most common abdominal emergency in children and young adults. There are a lot of serotonin-containing cells in the appendix, which release serotonin into the bloodstream in response to inflammation. Consequently, serotonin is converted to 5-hydroxyindoleacetic acid (5-HIAA) and secreted into the urine. On this basis, urinary 5-HIAA could be a marker for acute appendicitis. In this study, we investigated the value of 5-HIAA levels in spot urine in the diagnosis of acute appendicitis. METHODS The urinary 5-HIAA was measured by an enzyme-linked immunosorbent assay in the spot urine of 70 patients who presented to the emergency department with a clinical picture of acute appendicitis. Urine concentration results were correlated to final histopathologic reports, and the diagnostic value of this factor was measured. RESULTS Diagnosis of appendicitis was confirmed by histopathologic reports in 59 of 70 patients with presumptive diagnosis of appendicitis. Considering 5.25 mg/L as the cutoff point for urinary 5-HIAA, 28 patients had high urinary 5-HIAA levels, whereas 42 patients had values within reference range. The sensitivity and specificity of this test was 44% and 81%, respectively. CONCLUSIONS The measurement of urinary 5-HIAA levels is not an ideal diagnostic tool for ruling out or determination of acute appendicitis.
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Affiliation(s)
- Ali Jangjoo
- Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Determination of the source of increased serotonin (5-HT) concentrations in blood and peritoneal fluid of colic horses with compromised bowel. Equine Vet J 2010; 40:326-31. [DOI: 10.2746/042516408x293583] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kentsis A, Lin YY, Kurek K, Calicchio M, Wang YY, Monigatti F, Campagne F, Lee R, Horwitz B, Steen H, Bachur R. Discovery and validation of urine markers of acute pediatric appendicitis using high-accuracy mass spectrometry. Ann Emerg Med 2010; 55:62-70.e4. [PMID: 19556024 PMCID: PMC4422167 DOI: 10.1016/j.annemergmed.2009.04.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 03/29/2009] [Accepted: 04/29/2009] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVE Molecular definition of disease has been changing all aspects of medical practice, from diagnosis and screening to understanding and treatment. Acute appendicitis is among many human conditions that are complicated by the heterogeneity of clinical presentation and shortage of diagnostic markers. Here, we sought to profile the urine of patients with appendicitis, with the goal of identifying new diagnostic markers. METHODS Candidate markers were identified from the urine of children with histologically proven appendicitis by using high-accuracy mass spectrometry proteome profiling. These systemic and local markers were used to assess the probability of appendicitis in a blinded, prospective study of children being evaluated for acute abdominal pain in our emergency department. Tests of performance of the markers were evaluated against the pathologic diagnosis and histologic grade of appendicitis. RESULTS Test performance of 57 identified candidate markers was studied in 67 patients, with median age of 11 years, 37% of whom had appendicitis. Several exhibited favorable diagnostic performance, including calgranulin A (S100-A8), alpha-1-acid glycoprotein 1 (orosomucoid), and leucine-rich alpha-2-glycoprotein (LRG), with the receiver operating characteristic area under the curve and values of 0.84 (95% confidence interval [CI] 0.72 to 0.95), 0.84 (95% CI 0.72 to 0.95), and 0.97 (95% CI 0.93 to 1.0), respectively. LRG was enriched in diseased appendices, and its abundance correlated with severity of appendicitis. CONCLUSION High-accuracy mass spectrometry urine proteome profiling allowed identification of diagnostic markers of acute appendicitis. Usage of LRG and other identified biomarkers may improve the diagnostic accuracy of clinical evaluations of appendicitis.
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Affiliation(s)
- Alex Kentsis
- Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
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The importance of urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis. Am J Emerg Med 2009; 27:409-12. [DOI: 10.1016/j.ajem.2008.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Revised: 02/12/2008] [Accepted: 03/06/2008] [Indexed: 01/06/2023] Open
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Hernandez R, Jain A, Rosiere L, Henderson SO. A prospective clinical trial evaluating urinary 5-hydroxyindoleacetic acid levels in the diagnosis of acute appendicitis. Am J Emerg Med 2008; 26:282-6. [DOI: 10.1016/j.ajem.2007.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 05/11/2007] [Accepted: 05/14/2007] [Indexed: 10/22/2022] Open
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