ReviewFrontiers in medicine2025
The diagnostic utility of urinary 5-HIAA and leucine-rich alpha-2 glycoprotein in acute appendicitis: a narrative review.
Review in Frontiers in medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
- Salivary Biomarkers in Pediatric Acute Appendicitis: Current Evidence and Future Directions.Children (Basel, Switzerland) · 2025Review
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Acute appendicitis (AA) remains diagnostically challenging despite its global prevalence. Current methods rely on clinical scoring systems (e.g., Alvarado score) and imaging (US, CT, and MRI). Urinary biomarkers like 5-hydroxyindoleacetic acid (5-HIAA) and leucine-rich alpha-2 glycoprotein (LRG) offer non-invasive potential, reflecting intestinal inflammation and neutrophilic activity, respectively. This review evaluates their diagnostic accuracy. Methods: A targeted literature review was conducted using PubMed, Scopus, and ScienceDirect (2004-April 2025) to identify studies investigating urinary 5-HIAA and LRG in AA. Inclusion criteria focused on peer-reviewed studies reporting diagnostic accuracy, biomarker performance, and clinical utility. Data were extracted from 13 studies (2,623 participants) for 5-HIAA and 11 studies (1,586 participants) for LRG, including meta-analyses where available. Results were synthesized narratively, with emphasis on sensitivity, specificity, and area under the curve (AUC) metrics. Results: 5-HIAA demonstrated variable diagnostic performance, with pooled sensitivity of 68.6% and specificity of 82% (AUC ~0.64). While it showed higher sensitivity (82%) in perforated appendicitis, its utility in uncomplicated cases was limited by dietary interference and methodological heterogeneity. In contrast, LRG exhibited greater consistency, particularly in pediatric populations. Serum LRG achieved an AUC of 0.95, while creatinine-adjusted urinary LRG, when combined with clinical variables [e.g., appendicitis urine biomarker (AuB) score], reached 97.6% sensitivity for ruling out AA. However, standalone urinary LRG had low sensitivity (17.65%), highlighting its role as an adjunct rather than an independent diagnostic tool. Both biomarkers performed optimally when integrated with clinical scoring systems (e.g., pediatric appendicitis score) or imaging. Conclusions: While 5-HIAA and LRG offer non-invasive diagnostic potential, neither biomarker is sufficient as a standalone test for AA. 5-HIAA may aid in perforation risk stratification, whereas LRG excels in ruling out AA, particularly in pediatric cases. Future research should focus on standardizing assays, validating multimodal biomarker panels [e.g., 5-HIAA + LRG + CRP (C-reactive protein)], and developing point-of-care applications to enhance clinical feasibility. Until then, these biomarkers should complement-not replace-existing diagnostic strategies, serving as valuable adjuncts in ambiguous or high-risk presentations.
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