Annals of Emergency Medicine
Volume 55, Issue 1 , Pages 62-70.e4 , January 2010

Discovery and Validation of Urine Markers of Acute Pediatric Appendicitis Using High-Accuracy Mass Spectrometry

  • Alex Kentsis, MD, PhD

      Affiliations

    • Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA
    • Proteomics Center at Children's Hospital Boston, Boston, MA
  • ,
  • Yin Yin Lin, BS

      Affiliations

    • Proteomics Center at Children's Hospital Boston, Boston, MA
  • ,
  • Kyle Kurek, MD

      Affiliations

    • Proteomics Center at Children's Hospital Boston, Boston, MA
    • Department of Pathology, Children's Hospital Boston, Harvard Medical School, Boston, MA
  • ,
  • Monica Calicchio, PhD

      Affiliations

    • Department of Pathology, Children's Hospital Boston, Harvard Medical School, Boston, MA
  • ,
  • Yan Yan Wang, MD

      Affiliations

    • Proteomics Center at Children's Hospital Boston, Boston, MA
    • Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Flavio Monigatti, PhD

      Affiliations

    • Proteomics Center at Children's Hospital Boston, Boston, MA
    • Department of Pathology, Children's Hospital Boston, Harvard Medical School, Boston, MA
  • ,
  • Fabien Campagne, PhD

      Affiliations

    • Department of Physiology and Biophysics and HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Medical College of Cornell University, New York, NY
  • ,
  • Richard Lee, MD

      Affiliations

    • Proteomics Center at Children's Hospital Boston, Boston, MA
  • ,
  • Bruce Horwitz, MD, PhD

      Affiliations

    • Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA
    • Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Hanno Steen, PhD

      Affiliations

    • Proteomics Center at Children's Hospital Boston, Boston, MA
    • Department of Pathology, Children's Hospital Boston, Harvard Medical School, Boston, MA
  • ,
  • Richard Bachur, MD

      Affiliations

    • Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA
    • Corresponding Author InformationAddress for correspondence: Richard Bachur, MD, 300 Longwood Ave., Boston, MA 02115; 617-355-6624, fax 617-730-0335; or 617-919-2629, fax 617-730-0168

Received 7 January 2009 ,Revised 29 March 2009 ,Accepted 29 April 2009.

References 

  1. Addiss DG, Shaffer N, Fowler BS, et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910–925
  2. Henderson J, Goldacre MJ, Fairweather JM, et al. Conditions accounting for substantial time spent in hospital in children aged 1-14 years. Arch Dis Child. 1992;67:83–86
  3. Rappaport WD, Peterson M, Stanton C. Factors responsible for the high perforation rate seen in early childhood appendicitis. Am Surg. 1989;55:602–605
  4. Williams N, Bello M. Perforation rate relates to delayed presentation in childhood acute appendicitis. J R Coll Surg Edinb. 1998;43:101–102
  5. Rao PM, Rhea JT, Novelline RA, et al. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998;338:141–146
  6. Peck J, Peck A, Peck C. The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis. Am J Surg. 2000;180:133–136
  7. Partrick DA, Janik JE, Janik JS, et al. Increased CT scan utilization does not improve the diagnostic accuracy of appendicitis in children. J Pediatr Surg. 2003;38:659–662
  8. Rodriguez DP, Vargas S, Callahan MJ, et al. Appendicitis in young children: imaging experience and clinical outcomes. AJR Am J Roentgenol. 2006;186:1158–1164
  9. Doria AS, Moineddin R, Kellenberger CJ, et al. US or CT for diagnosis of appendicitis in children and adults? (a meta-analysis). Radiology. 2006;241:83–94
  10. Pena BM, Taylor GA, Lund DP, et al. Effect of computed tomography on patient management and costs in children with suspected appendicitis. Pediatrics. 1999;104(3 pt 1):440–446
  11. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–2284
  12. Taha AS, Grant V, Kelly RW. Urinalysis for interleukin-8 in the non-invasive diagnosis of acute and chronic inflammatory diseases. Postgrad Med J. 2003;79:159–163
  13. Bolandparvaz S, Vasei M, Owji AA, et al. Urinary 5-hydroxy indole acetic acid as a test for early diagnosis of acute appendicitis. Clin Biochem. 2004;37:985–989
  14. Apak S, Kazez A, Ozel SK, et al. Spot urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis. J Pediatr Surg. 2005;40:1436–1439
  15. Rivera-Chavez FA, Peters-Hybki DL, Barber RC, et al. Innate immunity genes influence the severity of acute appendicitis. Ann Surg. 2004;240:269–277
  16. Paajanen H, Mansikka A, Laato M, et al. Novel serum inflammatory markers in acute appendicitis. Scand J Clin Lab Invest. 2002;62:579–584
  17. Kafetzis DA, Velissariou IM, Nikolaides P, et al. Procalcitonin as a predictor of severe appendicitis in children. Eur J Clin Microbiol Infect Dis. 2005;24:484–487
  18. Tsuji M, Puri P, Reen DJ. Characterisation of the local inflammatory response in appendicitis. J Pediatr Gastroenterol Nutr. 1993;16:43–48
  19. Mazzucchelli L, Hauser C, Zgraggen K, et al. Expression of interleukin-8 gene in inflammatory bowel disease is related to the histological grade of active inflammation. Am J Pathol. 1994;144:997–1007
  20. Rai AJ, Stemmer PM, Zhang Z, et al. Analysis of Human Proteome Organization Plasma Proteome Project (HUPO PPP) reference specimens using surface enhanced laser desorption/ionization-time of flight (SELDI-TOF) mass spectrometry: multi-institution correlation of spectra and identification of biomarkers. Proteomics. 2005;5:3467–3474
  21. Pisitkun T, Johnstone R, Knepper MA. Discovery of urinary biomarkers. Mol Cell Proteomics. 2006;5:1760–1771
  22. Adachi J, Kumar C, Zhang Y, et al. The human urinary proteome contains more than 1500 proteins, including a large proportion of membrane proteins. Genome Biol. 2006;7:R80
  23. Woroniecki RP, Orlova TN, Mendelev N, et al. Urinary proteome of steroid-sensitive and steroid-resistant idiopathic nephrotic syndrome of childhood. Am J Nephrol. 2006;26:258–267
  24. Oetting WS, Rogers TB, Krick TP, et al. Urinary beta2-microglobulin is associated with acute renal allograft rejection. Am J Kidney Dis. 2006;47:898–904
  25. Berger RP, Kochanek PM. Urinary S100B concentrations are increased after brain injury in children: a preliminary study. Pediatr Crit Care Med. 2006;7:557–561
  26. Propst A, Propst T, Herold M, et al. Interleukin-1 receptor antagonist in differential diagnosis of inflammatory bowel diseases. Eur J Gastroenterol Hepatol. 1995;7:1031–1036
  27. Campbell MJ. Estimating sample sizes for binary, ordered categorical, and continuous outcomes in two group comparisons. BMJ. 1995;311:1145–1148
  28. Beltran MA, Almonacid J, Vicencio A, et al. Predictive value of white blood cell count and C-reactive protein in children with appendicitis. J Pediatr Surg. 2007;42:1208–1214
  29. Carvalho PC, Hewel J, Barbosa VC, et al. Identifying differences in protein expression levels by spectral counting and feature selection. Genet Mol Res. 2008;7:342–356
  30. Murphy CG, Glickman JN, Tomczak K, et al. Acute appendicitis is characterized by a uniform and highly selective pattern of inflammatory gene expression. Mucosal Immunol. 2008;1:297–308
  31. Kentsis A, Topisirovic I, Culjkovic B, et al. Ribavirin suppresses eIF4E-mediated oncogenic transformation by physical mimicry of the 7-methyl guanosine mRNA cap. Proc Natl Acad Sci U S A. 2004;101:18105–18110
  32. Kharbanda AB, Taylor GA, Bachur RG. Suspected appendicitis in children: rectal and intravenous contrast-enhanced versus intravenous contrast-enhanced CT. Radiology. 2007;243:520–526
  33. Okamoto T, Sano K, Ogasahara K. Receiver-operating characteristic analysis of leukocyte counts and serum C-reactive protein levels in children with advanced appendicitis. Surg Today. 2006;36:515–518
  34. Bundy DG, Byerley JS, Liles EA, et al. Does this child have appendicitis?. JAMA. 2007;298:438–451
  35. Kharbanda AB, Taylor GA, Fishman SJ, et al. A clinical decision rule to identify children at low risk for appendicitis. Pediatrics. 2005;116:709–716
  36. Murphy CG, Glickman JN, Tomczak K, et al. Acute appendicitis is characterized by a uniform and highly selective pattern of inflammatory gene expression. Mucosal Immunol. 2008;1:297–308
  37. O'Donnell LC, Druhan LJ, Avalos BR. Molecular characterization and expression analysis of leucine-rich alpha2-glycoprotein, a novel marker of granulocytic differentiation. J Leukoc Biol. 2002;72:478–485
  38. Saito K, Tanaka T, Kanda H, et al. Gene expression profiling of mucosal addressin cell adhesion molecule-1+ high endothelial venule cells (HEV) and identification of a leucine-rich HEV glycoprotein as a HEV marker. J Immunol. 2002;168:1050–1059
  39. Bini L, Magi B, Marzocchi B, et al. Two-dimensional electrophoretic patterns of acute-phase human serum proteins in the course of bacterial and viral diseases. Electrophoresis. 1996;17:612–616
  40. Weivoda S, Andersen JD, Skogen A, et al. ELISA for human serum leucine-rich alpha-2-glycoprotein-1 employing cytochrome c as the capturing ligand. J Immunol Methods. 2008;336:22–29

 Supervising editors: Kelly D. Young, MD, MS; Steven M. Green, MD

 Author contributions: AK, HS, and RB were responsible for research design. AK, YYL, MC, YYW, RL, and BH conducted laboratory processing. AK, KK, FM, FC, and BH conducted data analysis. AK, HS, and RB wrote the article. RB takes responsibility for the paper as a whole. HS and RB contributed equally to the article.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Funded in part by the Frederick Lovejoy, Jr, MD Housestaff Research and Education grant, and by Children's Hospital Boston Houseofficer Development Award.

 Publication date: Available online June 25, 2009.

 Reprints not available from the authors.

 Please see page 63 for the Editor's Capsule Summary of this article.

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

PII: S0196-0644(09)00481-8

doi: 10.1016/j.annemergmed.2009.04.020

Annals of Emergency Medicine
Volume 55, Issue 1 , Pages 62-70.e4 , January 2010