Appendicitis Could Be Detected with Urine Test
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| By John Gever, Senior Editor, MedPage Today Published: June 23, 2009 Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner |
- Explain to interested patients that symptoms of appendicitis, especially in its early stages, resemble those of many other conditions.
- Note that up to 30% of appendectomies prove to be unnecessary and that 30% to 45% of appendicitis cases involve rupture before surgery is performed.
- Explain that the results of this study were obtained in a relatively small number of patients and need to be confirmed prospectively in a larger sample.
- Explain that the biomarkers identified in this study are investigational; no FDA approved test based on them is available.
In particular, leucine-rich alpha-2-glycoprotein (LRG) was both specific and sensitive as a marker of appendicitis in 67 children with suspected appendicitis, reported Richard Bachur, MD, of Children's Hospital in Boston, and colleagues online in Annals of Emergency Medicine.
The area under the receiver-operator characteristic curve for LRG was 0.97 (95% CI 0.93 to 1.0), indicating low proportions of both false negatives and false positives, the researchers found.
For example, at a sensitivity of 90%, the specificity was about 97%. With a different cutoff value for LRG concentration such that the specificity was 100%, the sensitivity was about 70%.
LRG was also highly concentrated in diseased appendices, the researchers found.
Wrote Dr. Bachur and colleagues, "LRG appears to be enriched in the urine of patients with appendicitis in the absence of macroscopic inflammatory changes."
They noted that the protein was markedly elevated in two patients with histologically confirmed acute appendicitis whose imaging findings were normal. /.../
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