Abstract：
Background: Pediatric acute appendicitis (PAA) involves a substantial consumption of health and economic resources. The identification of serum biomarkers that may help predict the post-surgical evolution of these patients is a field of great interest. Patients and Methods: This was a prospective, observational substudy within the Biomarkers for the Diagnosis of Appendicitis in Pediatrics (BIDIAP) cohort aimed at evaluating the association between post-surgical increase in serum IL-6 and different outcomes related to the clinical evolution of children operated on for PAA. Sixty-nine children with a confirmed diagnosis of acute appendicitis and both pre-operative and post-operative serum IL-6 were included in the study. Three multivariable-adjusted linear regression models were fitted to analyze the association between an increase of >10% in post-operative serum IL-6 level with the length of stay, the number of post-operative emetic episodes, and the onset of oral feeding. Two multivariable-adjusted logistic regression models were fitted to assess the association of the same exposure with the indication of antibiotherapy at discharge and with positivity in peritoneal fluid culture. Results: Thirteen children showed an increase of >10% in the post-operative serum IL-6 value (group 1) whereas 56 showed only a minor increase, or no change (group 2). After accounting for potential confounders, children in group 1 had a mean of three-day longer hospital stay (difference, 3.33; 95% confidence interval [CI], 0.57-6.09) and higher odds of a positive result in peritoneal fluid culture (odds ratio [OR], 37.43; 95% CI, 1.02-1361.28) than children in group 2. Conclusions: An increase of >10% in post-operative serum IL-6 value could predict longer hospital stay and higher odds of positive peritoneal fluid culture. Future prospective studies are needed to replicate these findings and to broaden the range of biomarkers that could predict the post-operative evolution of children operated on for PAA.
摘要：
背景：小儿急性阑尾炎（PAA）涉及大量消耗健康和经济资源。可以帮助预测这些患者的术后进展的血清生物标志物的鉴定是非常感兴趣的领域。患者和方法：这是一个前瞻性的，儿科阑尾炎诊断生物标志物(BIDIAP)队列中的观察性子研究旨在评估手术后血清IL-6升高与PAA手术患儿临床进展相关的不同结局之间的关系.该研究纳入了69例确诊为急性阑尾炎的儿童以及术前和术后血清IL-6。拟合三个多变量调整线性回归模型，分析术后血清IL-6水平升高>10%与住院时间的关系。术后呕吐发作的次数,以及口服喂养的开始。拟合了两个多变量调整的逻辑回归模型，以评估相同的暴露量与出院时抗菌治疗的指征以及与腹膜液培养阳性的相关性。结果：13例患儿显示术后血清IL-6值增加>10％（第1组），而56例仅显示轻微增加，或无变化（第2组）。在考虑了潜在的混杂因素后，第1组的儿童平均住院时间长3天(差异，3.33；95%置信区间[CI]，0.57-6.09）和腹膜液培养中阳性结果的几率更高（优势比[OR]，37.43；95%CI，1.02-1361.28）比第2组儿童高。结论：术后血清IL-6值升高>10％可以预测住院时间更长和腹膜液培养阳性的可能性更高。需要未来的前瞻性研究来复制这些发现，并扩大生物标志物的范围，这些生物标志物可以预测接受PAA手术的儿童的术后演变。
