The diagnostic value of hepcidin to predict the presence and severity of appendicitis in children

The aim of this study was to determine the diagnostic capacity of hepcidin in pediatric acute appendicitis and its accuracy as a predictor of the severity of appendicitis. In children with appendicitis ( n  = 39), leukocytes, platelet count, and the serum levels of C-reactive protein (CRP) and hepcidin were compared to a control group ( n  = 25) of patients with unspecific abdominal pain. Additionally, parameters were compared between children with simple ( n  = 17) and complicated appendicitis ( n  = 22). Receiver operation characteristic analyses of the different parameters were performed and the areas under the curve (AUCs) calculated. Leukocytes and serum hepcidin levels were significantly higher in children with acute appendicitis versus control group (13.7 ± 5.7 versus 9.8 ± 3.9 G/L, P  = 0.005 and 31.3 ± 21.7 versus 20.4 ± 14 ng/mL, P  = 0.039). AUCs for hepcidin, leukocytes, and CRP were 0.654, 0.711, and 0.619, respectively. Complicated appendicitis was associated with significantly higher hepcidin concentrations compared to simple appendicitis (38.5 ± 17.6 ng/mL versus 21.6 ± 23.4 ng/mL, P  < 0.001). A combination of leukocytes, CRP, and hepcidin had the highest AUC (0.914) to predict complicated appendicitis. Increased serum levels of hepcidin were found in children with appendicitis compared to controls. While hepcidin was useful to identify patients with complicated appendicitis as it does not seem appropriate to distinguish between simple appendicitis and other causes for acute abdominal pain.