A Novel Nomogram for the Differential Diagnosis Between Advanced and Early Appendicitis in Pediatric Patients

Abstract

Aim: To develop a nomogram for differential diagnosis between advanced and early pediatric appendicitis (PA). Patients & methods: We retrospectively studied 669 PA patients. Patient characteristics and 24 serum markers were subjected to univariate and multivariate analysis, based on which the nomogram was constructed. Results: Fibrin degradation product, CRP and Na⁺ differed significantly between the advanced and early PA. The value of area under the receiver operating characteristic curve (AUC) was 0.8602, which was greater than that of a single serum marker. Furthermore, the nomogram showed better discriminative ability than the biomarker alone. Notably, validation indicated high stability and reproducibility. Conclusion: The nomogram is superior to the serum marker alone, and may hold promise in clinical application.

Keywords:

• appendicitis
• C-reactive protein
• fibrin degradation product
• nomogram
• pediatric appendicitis

Financial & competing interests disclosure

This study received financial support from Shanghai Hospital Development Center (SHDC12014106), Shanghai Key Disciplines (no.2017ZZ02022), the National Natural Science Foundation of China (no. 81370472, no. 81770519, no. 81771633, no. 81401243 and no. 81500394), Shanghai Rising-Star Program (A type; no. 15QA1400800), the Science Foundation of Shanghai Excellent Youth Scholars (no. 2017YQ042) and the Science Foundation of Shanghai (no. 16411952200, no. 16140902300 and no. 17411960600). Y Zheng is an employee of Wuxi Diagnosis, Wuxi Apptec. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The study protocol was reviewed and approved by the Institutional Review Board of the Children’s Hospital of Fudan University (Shanghai, China). Since it is a retrospective study, all analysis was based on the clinical data only and all patients enrolled were anonymized. Thus, the need for informed consent was waived. The study was conducted in compliance with the Declaration of Helsinki.

Additional information

Funding

This study received financial support from Shanghai Hospital Development Center (SHDC12014106), Shanghai Key Disciplines (no.2017ZZ02022), the National Natural Science Foundation of China (no. 81370472, no. 81770519, no. 81771633, no. 81401243 and no. 81500394), Shanghai Rising-Star Program (A type; no. 15QA1400800), the Science Foundation of Shanghai Excellent Youth Scholars (no. 2017YQ042) and the Science Foundation of Shanghai (no. 16411952200, no. 16140902300 and no. 17411960600). Y Zheng is an employee of Wuxi Diagnosis, Wuxi Apptec. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript