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CIRCULATING FIBROCYTES ARE AN ACCURATE DIAGNOSTIC BIOMARKER IN UNCOMPLICATED APPENDICITIS
Mohamed A. Zarog*2,1, Jarlath C. Bolger2, Miranda G. Kiernan1, Donal P. O'Leary2, Paul Tibbitts1, Aoife J. Lowery1,2, G J. Byrnes2,1, John C. Coffey2,1
1Graduate Entry Medical School, University of Limerick, Limerick, Ireland; 2Department of surgery, University Hospital Limerick, Limerick, Ireland
BACKGROUND: Accurate diagnostic biomarkers for appendicitis are lacking. 1 Circulating fibrocytes (CF) are increased in inflammatory states. It is not known whether they are altered in appendicitis nor how they may change in differing types of appendicitis. This study aimed to assess the diagnostic accuracy of CF, white cell count (WCC) and C-reactive protein (CRP) in differentiating between normal appendix (NA), uncomplicated appendicitis (UA) and complicated appendicitis (CA) in patients presenting with right iliac fossa pain.
METHODS: 101 consecutive adult patients with right iliac fossa pain were recruited in a cohort based prospective study between 1st June 2015 and 13th March 2016, at a single institution. Peripheral venous samples were obtained at presentation. Clinical, biochemical and histo-pathological parameters were recorded. CF levels were determined by dual-staining for CD45 and Col-1 using FACS and correlated with histopathological diagnoses. P<0.05 was taken as significant.
RESULTS: Of the sixty patients who underwent appendectomy, forty-six (76.6%) had a histologically inflamed appendix. CF levels were significantly elevated in patients with UA versus NA (6.36 ±4.9 vs. 3.05 ± 1.48, p<0.01). The diagnostic accuracy of CF in differentiating of UA from NA was better than that of the WCC and CRP, as reflected in an area under the curve (AUC) of 0.77, 0.68 and 0.70 respectively. CRP was the most accurate biomarker in differentiating CA from UA with an (AUC) of 0.88, compared to 0.57 and 0.60 for CF and WCC respectively.
CONCLUSIONS: CF levels are elevated in acute appendicitis. As a diagnostic biomarker, they are more accurate than standard biochemical indices in diagnosis of uncomplicated appendicitis. CRP remains the most accurate biomarker in identification of complicated appendicitis.
Conflict of interest & disclosure: none.
REFERENCES:
1. Sahebally S, Burke J, Chang K, Kiernan M, O'Connell P, Coffey J. Circulating fibrocytes and Crohn's disease. British Journal of Surgery. 2013;100(12):1549-1556.
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