CC BY 4.0 · Journal of Child Science 2023; 13(01): e96-e103
DOI: 10.1055/s-0043-1770147
Original Article

The Pattern of Nutritional and Inflammatory Parameters in Children with Acute Appendicitis

1   Pediatric Clinical Nutrition Division, Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
,
Sherif Kaddah
2   Pediatric Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
,
Osama M. El-Asheer
3   Pediatric Department, Faculty of Medicine, Assiut University, Assiut, Egypt
,
Manal Mahmoud
2   Pediatric Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
,
Ahemd Wishahy
2   Pediatric Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
› Author Affiliations

Abstract

Background Surgical procedures in children with overweight and obesity have many difficulties due to the high incidence of postoperative complications. This impact on comorbidity has a great interest in various surgical pathologies, such as acute appendicitis, since it is the most frequent surgical emergency in all age and sex groups. However, there are few studies assessing the effect of body mass index (BMI) and other parameters like the Glasgow Prognostic Score (GPS) and C-reactive protein (CRP)/albumin ratio on the course of acute appendicitis in children.

Objectives Identify the impact of BMI and other biomarkers like CRP/albumin ratio and GPS on the clinical course of acute appendicitis in children.

Patients (Materials) and Methods This is a prospective study conducted on 90 pediatric patients of acute appendicitis (30 high BMI and 60 non-high BMI) admitted at Pediatric Surgery Department, Children Hospital Cairo University (CHCU) during the period from March 2022 to September 2022. All patients had preoperative laboratory tests, intraoperative assessment regarding the type of surgery, duration of surgery, and type of appendicitis, then the postoperative assessment.

Results Among the 90 patients, the mean age of participants was 8.74 (2.23) years and there was a male predominance. Frequencies of open surgeries were higher in overweight and obese children (children with high BMI). There was a significant positive correlation between the preoperative CRP/albumin ratio and GPS, and an inverse significant correlation of preoperative albumin with the postoperative hospital length of stay, duration of surgery (operation time), and duration of postoperative fever.

Conclusion There is a significant relationship between the preoperative inflammatory and nutritional markers and postoperative hospital length of stay, duration of surgery (operation time), and duration of postoperative fever.

Authors' Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by H.A.A.I. and M.M. The first draft of the manuscript was written by H.A.A.I. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.


Recommendation

Health priorities should be directed toward children with higher CRP, CRP/albumin ratio, and GPS in cases of acute appendicitis as they may have higher risks for postoperative hospital length of stay.


Availability of Data and Materials

The data are available with the corresponding author upon a reasonable request




Publication History

Received: 20 March 2023

Accepted: 06 May 2023

Article published online:
27 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Hawn MT, Bian J, Leeth RR. et al. Impact of obesity on resource utilization for general surgical procedures. Ann Surg 2005; 241 (05) 821-826 , discussion 826–828
  • 2 Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: a review. J Am Coll Surg 1997; 185 (06) 593-603
  • 3 Dindo D, Muller MK, Weber M, Clavien PA. Obesity in general elective surgery. Lancet 2003; 361 (9374): 2032-2035
  • 4 Davies DA, Yanchar NL. Appendicitis in the obese child. J Pediatr Surg 2007; 42 (05) 857-861
  • 5 Ferris M, Quan S, Kaplan BS. et al. The global incidence of appendicitis: a systematic review of population-based studies. Ann Surg 2017; 266 (02) 237-241
  • 6 Garey CL, Laituri CA, Keckler SJ. et al. Laparoscopic cholecystectomy in obese and non-obese children. J Surg Res 2010; 163 (02) 299-302
  • 7 Kinoshita A, Onoda H, Imai N. et al. Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma. Br J Cancer 2012; 107 (06) 988-993
  • 8 Aslan MK, Cesur O, Soyer T, Hancerliogullari O, Turkmen F, Cakmak M. The effect of body mass index on the clinical course of appendicitis in children. Turk Klin J Med Sci 2012; 32 (06) 1518-1521
  • 9 Anand S, Krishnan N, Birley JR, Tintor G, Bajpai M, Pogorelić Z. Hyponatremia-a new diagnostic marker for complicated acute appendicitis in children: a systematic review and meta-analysis. Children (Basel) 2022; 9 (07) 1070
  • 10 Naqvi SA, Thompson GC, Joffe AR. et al. Cytokines and chemokines in pediatric appendicitis: a multiplex analysis of inflammatory protein mediators. Mediators Inflamm 2019; 2019: 2359681
  • 11 Arredondo Montero J, Bronte Anaut M, Bardají Pascual C, Antona G, López-Andrés N, Martín-Calvo N. Alterations and diagnostic performance of capillary ketonemia in pediatric acute appendicitis: a pilot study. Pediatr Surg Int 2022; 39 (01) 44
  • 12 Anand S, Pakkasjärvi N, Bajpai M. et al. Utility of Pentraxin-3 as a biomarker for diagnosis of acute appendicitis: a systematic review and meta-analysis. Pediatr Surg Int 2022; 38 (08) 1105-1112
  • 13 Bakal U, Saraç M, Ciftci H. et al. Neutrophil gelatinase-associated lipocal in protein levels as an acute appendicitis biomarker in children. Springerplus 2016; 5: 193
  • 14 Arredondo Montero J, Bardají Pascual C, Antona G, Ros Briones R, López-Andrés N, Martín-Calvo N. The BIDIAP index: a clinical, analytical and ultrasonographic score for the diagnosis of acute appendicitis in children. Pediatr Surg Int 2023; 39 (01) 175
  • 15 Gadiparthi R, Waseem M. Pediatric Appendicitis. [Updated 2022 Aug 7]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022
  • 16 Atef Abdelsattar Ibrahim H, Abdallah Nasr R, Adel Salama A, Ahmed Amin A. Childhood malnutrition and hypo mineralized molar defects; a cross sectional study, Egypt. F1000 Res 2021; 10: 1307
  • 17 Atef H, Abdel-Raouf R, Zeid AS. et al. Development of a simple and valid nutrition screening tool for pediatric hospitalized patients with acute illness. F1000 Res 2021; 10: 173
  • 18 Liu Y, Zheng J, Zhang D, Jing L. Neutrophil-lymphocyte ratio and plasma lactate predict 28-day mortality in patients with sepsis. J Clin Lab Anal 2019; 33 (07) e22942
  • 19 Maeda K, Shibutani M, Otani H. et al. Inflammation-based factors and prognosis in patients with colorectal cancer. World J Gastrointest Oncol 2015; 7 (08) 111-117
  • 20 Xu JH, He XW, Li Q. et al. Higher platelet-to-lymphocyte ratio is associated with worse outcomes after intravenous thrombolysis in acute ischaemic stroke. Front Neurol 2019; 10: 1192
  • 21 Proctor MJ, Morrison DS, Talwar D. et al. An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer 2011; 104 (04) 726-734
  • 22 Al-Tarakji M, Zarour A, Singh R, Ghali MS. The role of Alvarado score in predicting acute appendicitis and its severity in correlation to histopathology: a retrospective study in a Qatar population. Cureus 2022; 14 (07) e26902
  • 23 Chan YH. Biostatistics 102: quantitative data--parametric & non-parametric tests. Singapore Med J 2003; 44 (08) 391-396
  • 24 Marzuillo P, Germani C, Krauss BS, Barbi E. Appendicitis in children less than five years old: a challenge for the general practitioner. World J Clin Pediatr 2015; 4 (02) 19-24
  • 25 Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A, Schwartzman A. National Hospital Discharge Survey: 2007 summary. Natl Health Stat Rep 2010; ; ( (29) 1-20, 24
  • 26 Tamakoshi K, Yatsuya H, Kondo T. et al. The metabolic syndrome is associated with elevated circulating C-reactive protein in healthy reference range, a systemic low-grade inflammatory state. Int J Obes Relat Metab Disord 2003; 27 (04) 443-449
  • 27 Valle M, Martos R, Gascón F, Cañete R, Zafra MA, Morales R. Low-grade systemic inflammation, hypoadiponectinemia and a high concentration of leptin are present in very young obese children, and correlate with metabolic syndrome. Diabetes Metab 2005; 31 (01) 55-62
  • 28 Shin JY, Kim SY, Jeung MJ. et al. Serum adiponectin, C-reactive protein and TNF-alpha levels in obese Korean children. J Pediatr Endocrinol Metab 2008; 21 (01) 23-29
  • 29 Ramos CT, Nieves-Plaza M. The association of body mass index and perforation of the appendix in Puerto Rican children. J Health Care Poor Underserved 2012; 23 (01) 376-385
  • 30 Delgado-Miguel C, Muñoz-Serrano AJ, Barrena Delfa S. et al. Influence of overweight and obesity on acute appendicitis in children. A cohort study [in Spanish]. Cir Pediatr 2020; 33 (01) 20-24
  • 31 Pearson TA, Mensah GA, Alexander RW. et al; Centers for Disease Control and Prevention; American Heart Association. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107 (03) 499-511
  • 32 Dayal D, Jain H, Attri SV, Bharti B, Bhalla AK. Relationship of high sensitivity C-reactive protein levels to anthropometric and other metabolic parameters in Indian children with simple overweight and obesity. J Clin Diagn Res 2014; 8 (08) PC05-PC08
  • 33 Raja MH, Elshaikh E, Williams L, Ahmed MH. The value of C-reactive protein in enhancing diagnosis of acute appendicitis. J Curr Surg 2017; 7 (1–2): 7-10
  • 34 Kim M, Kim SJ, Cho HJ. International normalized ratio and serum C-reactive protein are feasible markers to predict complicated appendicitis. World J Emerg Surg 2016; 11: 31
  • 35 Doğan S, Dorter M, Kalafat UM. et al. Diagnostic value of C-reactive protein/albumin ratio to differentiate simple versus complicated appendicitis. Eurasian J Emerg Med 2020; 19 (03) 178-183
  • 36 Straatman J, Cuesta MA, Tuynman JB, Veenhof AAFA, Bemelman WA, van der Peet DL. C-reactive protein in predicting major postoperative complications are there differences in open and minimally invasive colorectal surgery? Substudy from a randomized clinical trial. Surg Endosc 2018; 32 (06) 2877-2885
  • 37 Melese Ayele W. Prevalence of postoperative unfavorable outcome and associated factors in patients with appendicitis: a cross-sectional study. Open Access Emerg Med 2021; 13: 169-176
  • 38 Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial 2004; 17 (06) 432-437
  • 39 Galata C, Busse L, Birgin E. et al. Role of albumin as a nutritional and prognostic marker in elective intestinal surgery. Can J Gastroenterol Hepatol 2020; 2020: 7028216
  • 40 Dewi R, Silitonga F, Mangunatmadja I. Impact of albumin levels on clinical outcomes in children underwent abdominal surgery. PI [Internet] 2020; 60 (03) 149-3
  • 41 Noble F, Curtis N, Harris S. et al; South Coast Cancer Collaboration–Oesophago-Gastric (SC-OG). Risk assessment using a novel score to predict anastomotic leak and major complications after oesophageal resection. J Gastrointest Surg 2012; 16 (06) 1083-1095
  • 42 Zhao C, Ding C, Xie T. et al. Validation and optimization of the Systemic Inflammation-Based modified Glasgow Prognostic Score in predicting postoperative outcome of inflammatory bowel disease: preliminary data. Sci Rep 2018; 8 (01) 747-755