Research on acute uncomplicated and complicated appendicitis in children

Appendicitis in children poses a challenge throughout the course of the illness – from diagnosis to treatment.

It is important to differentiate between acute uncomplicated appendicitis and complicated appendicitis at the start of treatment, because acute uncomplicated appendicitis is treated non-surgically or conservatively, whereas complicated appendicitis requires emergency surgical treatment due to delayed diagnostic processes. In Latvia, acute complicated appendicitis accounts for more than 35% of all cases of appendicitis.

Due to the importance of early diagnosis and recognition of acute appendicitis, it is essential to find new early diagnostic indicators in children to reduce the incidence of complications and prevent the risk of mortality.

The aim of this thesis was to evaluate new urine and blood serum biomarkers, bacterial aetiology and antimicrobial susceptibility for early and accurate diagnosis of acute appendicitis, as well as differentiation of acute uncomplicated and complicated appendicitis in children.

The results show that urinary LRG1 (leucine-rich alpha-2 glycoprotein 1) is an accurate marker to confirm the diagnosis of acute appendicitis and serves as a non-invasive and rapid diagnostic tool. Serum and urine LRG1 concentrations allow for determining the severity of acute appendicitis and distinguishing acute uncomplicated appendicitis from complicated appendicitis. The biomarker NGAL (neutrophil gelatinase-associated lipocalin) in blood serum increases significantly during the acute period of the disease and it should be used in the diagnosis of acute abdominal pain. Due to their specific properties, CRO (C-reactive protein) and serum IL-6 (interleukin-6) are non-specific biomarkers but they can be further used for the diagnosis of acute appendicitis.

Pseudomonas aeruginosa was most frequently detected in acute complicated appendicitis. Its antimicrobial susceptibility differs from the current (empirical) treatment algorithm and should therefore be adjusted according to the available local bacterial susceptibility data. Antibodies to Yersinia enterocolitica were not detected in the serum of the patients included in the study and therefore cannot be used as a criterion for the diagnosis of acute appendicitis.

Mohit Kakar will defend his doctoral thesis Clinical, Molecular Biological, and Microbiological Integrated Investigation in the Case of Paediatric Acute Complicated and Uncomplicated Appendicitis on 19 December 2023.  Read more

RSU dissertation database