ArticlePediatric surgery international2023
Acute appendicitis in children: is preoperative hyponatremia a predictive factor of perforation/gangrene? A prospective study.
Article in Pediatric surgery international, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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9 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Hyponatremia as a predictor of complicated appendicitis: a systematic review and meta-analysis.Biomarkers in medicine · 2024Pooled it
- Blood biomarkers and penalized logistic regression for the prediction of complicated appendicitis in children: a retrospective cohort study.Annals of medicine and surgery (2012) · 2026Article
- A Simple Preoperative Scoring System for Risk Stratification of Complicated Appendicitis in Children.Children (Basel, Switzerland) · 2026Article
- Article
- Early versus interval appendectomy in children with complicated appendicitis: effects on hospital stay and occurrence of severe complications.Frontiers in pediatrics · 2026Article
- The predictive value of neutrophil, C-reactive protein, fibrinogen, and chloride for acute complicated appendicitis in children: a multicenter retrospective study.Pediatric surgery international · 2025Article
- Plasma Sodium and Laboratory Parameters in Determining Complicated Appendicitis in Children.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2025Article
- Establishment and validation of a nomogram for predicting postoperative intestinal adhesion in children with acute appendicitis.BMC pediatrics · 2024Article
- Diagnostic Value of Serum Sodium Level and Neutrophil-to-Lymphocyte Ratio in Predicting Severity of Acute Appendicitis: A Retrospective Cross-Sectional Two-Center Study.Medicina (Kaunas, Lithuania) · 2024Article
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Authors and funding
5 authors at 2 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
purposeDistinguishing between perforated/gangrenous from uncomplicated appendicitis in children helps management. We evaluated hyponatremia as a new diagnostic marker for perforated/gangrenous appendicitis in children.
methodsA prospective study including all children with acute appendicitis who underwent appendectomy at our institution from May 2021 to May 2023. Medical history and clinical criteria were analyzed. All blood samples were taken upon admission including serum inflammatory markers and electrolytes. Patients were divided into two groups (Group I: uncomplicated and Group II: perforated/gangrenous), and data between both groups were compared.
resultsThe study included 153 patients [Group I: 111 (73%), Group II: 42 (27%)]. Mean serum sodium concentration in children with perforated/gangrenous appendicitis was significantly lower compared to children with uncomplicated appendicitis (131.8 mmol/L vs. 138.7 mmol/L; p < 0.001). The ROC curve of preoperative sodium level to differentiate between perforated/gangrenous and uncomplicated appendicitis revealed an AUC of 0.981. The cut-off-value of sodium level < 135 mmol/L identified perforated/gangrenous appendicitis with a sensitivity of 94% and a specificity of 91% (p < 0.001). Predictive factors of perforated/gangrenous appendicitis were: age less than 5 years (12% vs. 3%; p = 0.02), experiencing symptoms for more than 24 h (100% vs. 58%; p < 0.001), body temperature more than 38.5 °C (52% vs. 13%; p < 0.001), a serum sodium level less than 135 mmol/L (90% vs. 6%; p < 0.001), and a CRP serum level more than 50 mg/L (71% vs. 17%; p < 0.001).
conclusionsHyponatremia, upon admission, is a novel, objective biochemical marker that can identify perforated/gangrenous appendicitis in children. We advocate that the assessment of serum sodium level should be added to the diagnostic algorithm in children with suspected acute appendicitis. Surgical intervention in patients with hyponatremia should not be delayed, and non-operative management should be avoided.
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