SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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Mohammad Vasei, Shahram Boland Parvaz, Ali akbar Owji, Negar Ata-ee, Ali Amin, Yahya Daneshbod, seyedVahid Hosseini

1Department of Pathology ,Shiraz Medical School,Shiraz IRAN, 2Department Of Biochemistry,Shiraz Medical School,Shiraz IRAN, 3Department OF Surgery,Shiraz Medical School,Shiraz IRAN

Objectives:Acute appendicitis(AA)is the most common acute abdominal disease that prompts emergency management.The appendix has abundant neuroendocrine cells,which contain serotonin.Upon inflammation and cell destruction,serotonin is released in the blood, rapidly converted into 5-hydroxy indole acetic acid (5-HIAA) and secreted in the urine.Measurement of the urine 5-HIAA could be a reliable marker of inflammation of the appendix.We have compared the powers of test performance of spot urine 5-HIAA (U-5-HIAA) and spot U-5-HIAA/ creatinine with other routine laboratory tests using for the diagnosis of AA.
Methods:Urine, serum and blood samples of 110 patients who were admitted in the emergency units of two university hospitals were studied.5-HIAA was measured using HPLC, C-reactive protein by immunoturbidometry.Diagnostic accuracy of the various tests was evaluated by receiver operating characteristic (ROC) analysis.
Results:The mean of spot U-5-HIAA in 39 patients with AA (non gangrenous) was 32 +/-2.6 μmol/L which was much higher than the mean of 40 non-appendicitis patients (5.5+/-0.6), 10 follicular hyperplasia (7.5+/- 2.1) and 50 healthy control cases (4.1+/- 0.5) with P < 0.001. The concentration of U-5-HIAA in 21 patients with gangrenous appendicitis (13.8+/-2.1) was lower than AA cases .Considering10 μmol/L as the cut-off point this test shows 84% sensitivity,88% specificity,90%and 81% positive and negative predictive values, respectively.The areas under ROC curves(AUC) of U-5-HIAA in the diagnosis of AA (AUC=0.903)were much larger than U-5-HIAA/Cr(AUC=0.787), WBC(AUC=0.703)and CRP (AUC=0.660).
Conclusion:Urinary secretion of 5-HIAA increases significantly in acute appendicitis and measurement of spot U-5-HIAA gives higher diagnostic accuracy than other routine laboratory tests in preoperative diagnosis.While the inflammation progresses to necrosis of the appendix,the concentration of 5-HIAA decreases.This decrease could be a warning sign of perforation of the appendix.

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