The role of thiol-disulfide and ischemia-modified albumin levels in the diagnosis of childhood appendicitis

Aim: The accurate diagnosis of acute appendicitis can be achieved by a combination of evaluation of clinical symptoms, physical examination findings and history taking, but is still challenging for the clinician. Some biochemical markers have been evaluated for the purpose of increasing the diagnostic accuracy rate for appendicitis. In this study, our aim is to evaluate the diagnostic value of thiol-disulfide levels and IMA, in pediatric patients with suspected acute appendicitis. Materials And Methods: The children (1-17 years age) who were admitted to our clinic for suspected acute appendicitis between March 2017 and September 2017 were evaluated. A total of 238 children are enrolled in the study; 119 were operated for suspected acute appendicitis and the 119 children who did not have appendicitis constituted the control group. Serum levels of native thiol (-SH), total thiol (SH + SS), dynamic disulfide (SS), dynamic disulfide (SS)/total thiol (SH + SS) ratio, albumin, ischemic modified albumin (IMA) and WBC levels were obtained and compared within groups. Results: The mean age of the patients was 10.9 years (±3.7, 3-17 years) and 9.1 years (±3.7, 1-17 years) in the operation and the control groups, respectively. The SH, SH+SS, SS and albumin levels and SS/SH+SS ratio were significantly lower and IMA levels were significantly higher in the operation group than the control group. Among the operated patients, IMA and dynamic disulfide levels were significantly higher and WBC levels were significantly lower in patients with non-perforated appendicitis than patients with perforated appendicitis. A significant decrease in serum levels of IMA was observed in the postoperative 1st day when compared with the preoperative values. Conclusion: Measuring the IMA levels with thiol/disulfide homeostasis may increase the diagnostic accuracy rate when evaluating the patients with suspected appendicitis. However, it appears that these evaluations fail to distinguish the patients with perforated and non-perforated appendicitis, thus further studies are necessary.