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Clinical Chemistry and Laboratory Medicine (CCLM)

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Volume 56, Issue 6


Diagnosis of acute pediatric appendicitis from children with inflammatory diseases by combination of metabolic markers and inflammatory response variables

Mengjie Yu
  • Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, School of Pharmaceutical Science, Nanchang University, Nanchang, P.R. China
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/ Tianxin Xiang
  • Department of Infectious Disease, The First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
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/ Xiaoping Wu
  • Department of Infectious Disease, The First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
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/ Shouhua Zhang / Wenlong Yang
  • Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, School of Pharmaceutical Science, Nanchang University, Nanchang, P.R. China
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/ Yu Zhang
  • Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, School of Pharmaceutical Science, Nanchang University, Nanchang, P.R. China
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/ Qiang Chen / Shuilin Sun
  • Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, School of Pharmaceutical Science, Nanchang University, Nanchang, P.R. China
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/ Baogang Xie
  • Corresponding author
  • Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, School of Pharmaceutical Science, Nanchang University, Nanchang 330006, P.R. China, Phone: +86 791 86361839, Fax: +86 791 86361839
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Published Online: 2018-01-08 | DOI: https://doi.org/10.1515/cclm-2017-0858



The discovery of new metabolic markers may be helpful for early diagnosis of acute pediatric appendicitis (APA). However, no studies have been reported regarding identification of potential metabolic markers for the APA diagnosis by metabonomics.


Serum samples of APA (n=32), non-appendicitis inflammation (NAI, n=32) and healthy children (HS, n=65) were analyzed by the 1H NMR-based metabonomics. A logistic regression model was established to screen the most efficient markers combinations for classification. Forty double-blind samples were further validated the model.


Nine blood metabolites that were different in the APA group from other groups were identified. To differentiate APA from HS, single variable of acetate, formate, white blood cell (WBC) and C-reactive protein (CRP) showed a high diagnostic value (area under the receiver operating characteristic [AUROC]<0.92), while they had a weak diagnostic value (AUROC<0.77) for identifying the APA and NAI. By contrast, the AUROC values of leucine (0.799) were higher than that of WBC and CRP. A combination of five variables, i.e. leucine, lactate, betaine, WBC and CRP, showed a high diagnostic value (AUROC=0.973) for the APA discriminating from the NAI, and the sensitivity and specificity were 93.8% and 93.7%, respectively. Further double-blind sample prediction showed that the accuracy of the model was 85% for 40 unknown samples.


The current study provides useful information in our understanding of the metabolic alterations associated with APA and indicates that measurement of these metabolites in serum effectively aids in the clinical identification of APA.

This article offers supplementary material which is provided at the end of the article.

Keywords: acute pediatric appendicitis; diagnostic markers combination; metabonomics; non-appendicitis inflammatory children


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About the article

aMengjie Yu, Tianxin Xiang and Xiaoping Wu contributed equally to this work.

Received: 2017-09-23

Accepted: 2017-12-04

Published Online: 2018-01-08

Published in Print: 2018-05-24

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: The work was supported by a grant from the National Natural Science Foundation of China (grant nos. 81560631 and 81460118), The Distinguished Young Scholars Foundation of Jiangxi Province (grant no. 20162BCB23022) and the Innovation Fund Designated for Graduate Students of Nanchang University (grant no. cx2017271).

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 56, Issue 6, Pages 1001–1010, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2017-0858.

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