The importance of Galectin-3 in the diagnosis of childhood acute appendicitis.

Background/aim: Acute appendicitis (AA) is a frequent indication for emergency surgery in children; accurate diagnosis is essential to prevent complications. We examined whether serum Galectin-3 is associated with pediatric AA and quantified its diagnostic performance relative to routine inflammatory markers. Materials and methods: This prospective, single-center study was conducted in a tertiary emergency department between July 1, 2023, and January 31, 2024. Children younger than 18 years with pathologically confirmed AA were enrolled as cases; age-compatible healthy volunteers served as controls. Venous blood was obtained at presentation before any therapeutic intervention. Galectin-3 concentrations were quantified using a commercial enzyme-linked immunosorbent assay. The primary endpoint was the ability of Galectin-3 to discriminate AA from controls. Receiver operating characteristic analysis was performed to assess discrimination, yielding area under the curve estimates with 95% confidence intervals (CIs); sensitivity and specificity were quantified at prespecified thresholds. Results: Seventy-four children were analyzed (AA group n = 47; control group n = 27). Compared with controls, the AA group had higher Galectin-3, leukocyte and neutrophil counts, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lower lymphocyte counts and platelet-to-neutrophil ratio (PNR) (all p < 0.05). Galectin-3 yielded an area under the curve (AUC) value of 0.680 (95% CI, 0.55-0.81). At a threshold of >130.71 pg/mL, sensitivity was 91.49% and specificity was 33.33%; at >115.71 pg/mL, sensitivity was 100.00% with the same specificity; at >254.90 pg/mL, specificity was 92.30% with sensitivity 29.79%. Conclusion: Serum Galectin-3 is elevated in pediatric AA and affords moderate discrimination. Owing to limited specificity at pragmatic cut-offs, Galectin-3 alone is insufficient as a standalone test; however, it may serve as a rule-out adjunct within multimodal pathways. External validation in larger, multicenter cohorts is warranted.