Endocrine Abstracts

JOINT2840

Background: Abdominal pain is often associated with T1DM and DKA in children. Underlying causes include not only functional disorders and impaired motility of GIT but also common surgical emergencies, namely acute appendicitis (AA) and peritonitis. The neutrophil-to-lymphocyte ratio (NLR) has recently become a valuable tool for diagnosing DKA and endothelial dysfunction in T1DM. Moreover, several studies have shown that NLR serves as an indicator of systemic inflammation and reflects a balance between the latter and immunity. However, its prognostic discriminative role between surgical emergencies and abdominal pain in DKA in children with T1DM remains unclear.

Aim: We aimed to analyze the utility of NLR in the differential diagnosis of surgical (acute appendicitis and peritonitis) and non-surgical causes of acute abdominal pain in children with T1DM and/or DKA.

Material and Methods: 102 pediatric patients were enrolled in this study and further divided into three groups: group I – patients with DKA and acute abdominal pain (n = 21); group II (n = 70) - patients with acute appendicitis; group III (n = 11) – patients with acute appendicitis and T1DM/DKA. Diagnosis of acute appendicitis was confirmed by pathology. All patients underwent routine workup. Additionally, blood gases were evaluated in groups I and III. NLR was calculated as a ratio between the neutrophil and lymphocyte counts measured in peripheral blood. Written informed consent was obtained from the parents.

Results: The mean level of NLR was significantly different between group I (5. 06±3. 13) and two other groups with AA (group II – 9. 40±8. 03; group III – 9. 95 ±8. 6), P= 0, 01786; P = 0. 0254, respectively). However, there was no difference between groups II and III(P = 0. 8348). It may be due to the leading role of intraabdominal infection in the development of inflammation in both groups. Further ROC analysis has shown that NLR may be used as a prognostic marker of intraabdominal surgical diseases (AUC=0. 827; 95% CI = 0. 671-0. 983; p<0. 01) at a cut-off value of 7. 81 with sensitivity =72. 7% (CI= 43. 4-90. 2 %) and specificity =85. 7% (65. 3-95. 0 %), Youden’s index – 0. 58. We also found that NLR strongly inversely correlates with the LYM fraction of CBC (r_s= -0. 98; p<0. 0001). It shows the crucial role of immunity in the natural course of AA in children with T1DM.

Conclusion: NLR is significantly higher in children with T1DM and AA than in children with non-surgical acute abdominal pain. A cut-off value of 7. 81 may be used to predict the surgical cause of acute abdominal pain (AA) in children with T1DM and/or DKA.