{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:11:11Z","timestamp":1753891871841,"version":"3.41.2"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T00:00:00Z","timestamp":1623196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Objectives:<\/jats:bold> Appendicitis is a common abdominal emergency in children. It is difficult for clinicians to distinguish between simple appendicitis (SA), gangrenous appendicitis (GA), and ruptured appendicitis (RA) in children based on physical and current laboratory tests. Abdominal computed tomography with the disadvantage of excess radiation exposure is usually used in the emergency room for appendicitis surveys. Serum soluble CD40 ligand (sCD40L) is an inflammatory biomarker. This study aimed to use sCD40L to distinguish SA, GA, and RA.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> All patients aged &amp;lt;18 years old with suspected appendicitis were tested once for serum sCD40L within 72 h of appendicitis symptoms. We compared sCD40L levels of SA, GA, and RA individually on days 1, 2, and 3 in patients with normal appendix (NA), a total of nine subgroups. Thereafter, the diagnostic performance of sCD40L in predicting appendicitis and the receiver operating characteristic curves were carried out.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Of 116 patients, 42 patients had SA, 20 GA, 44 RA, and 10 NA. We found six subgroups with significant <jats:italic>p<\/jats:italic>-values of sCD40L predicting appendicitis as follows: SA on day 2, GA on days 2 and 3, and RA on days 1\u20133. The sensitivity and specificity of sCD40L at the best cutoff point with 178 pg\/mL in these six subgroups range from 0.75 to 1.00 and 0.90, respectively.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> SCD40L is a good predictor of pediatric appendicitis. Clinicians can use sCD40L to distinguish from SA, GA, and RA in children with suspected appendicitis.<\/jats:p>","DOI":"10.3389\/fped.2021.676370","type":"journal-article","created":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T05:33:48Z","timestamp":1623216828000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Serum Soluble CD40 Ligand in Predicting Simple Appendicitis and Complicated Appendicitis at Different Time Points in Children"],"prefix":"10.3389","volume":"9","author":[{"given":"Wun-Yan","family":"Huang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Yu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Jun","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"En-Pei","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han-Ping","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1007\/s00268-005-0350-0","article-title":"Diagnosis and treatment of acute appendicitis in children: a survey among Dutch surgeons and comparison with evidence-based practice","volume":"3","author":"Tan","year":"2006","journal-title":"World J Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1097\/MOP.0000000000000487","article-title":"Nonoperative management of appendicitis in children","volume":"29","author":"L\u00f3pez","year":"2017","journal-title":"Curr Opin Pediatr."},{"key":"B3","doi-asserted-by":"publisher","first-page":"19","DOI":"10.5409\/wjcp.v4.i2.19","article-title":"Appendicitis in children less than five years old: a challenge for the general practitioner","volume":"4","author":"Marzuillo","year":"2015","journal-title":"World J Clin Pediatr."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1111\/jpc.13737","article-title":"Acute appendicitis","volume":"53","author":"Stringer","year":"2017","journal-title":"J Paediatr Child Health."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1016\/S0140-6736(15)00275-5","article-title":"Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management","volume":"386","author":"Bhangu","year":"2015","journal-title":"Lancet."},{"key":"B6","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1089\/sur.2013.106","article-title":"Simple acute appendicitis versus non-perforated gangrenous appendicitis: is there a difference in the rate of post-operative infectious complications?","volume":"15","author":"Romano","year":"2014","journal-title":"Surg Infect."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1016\/j.ajem.2013.06.027","article-title":"Different urinalysis appearances in children with simple and perforated appendicitis","volume":"31","author":"Chen","year":"2013","journal-title":"Am J Emerg Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.ajem.2004.10.013","article-title":"Predictive value of C-reactive protein at different cutoff levels in acute appendicitis","volume":"23","author":"Wu","year":"2005","journal-title":"Am J Emerg Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1007\/s00383-017-4088-1","article-title":"Can common serum biomarkers predict complicated appendicitis in children?","volume":"33","author":"Zani","year":"2017","journal-title":"Pediatr Surg Int."},{"key":"B10","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1016\/j.annemergmed.2014.02.025","article-title":"What are the most clinically useful cutoffs for the alvarado and pediatric appendicitis scores? A systematic review","volume":"64","author":"Ebell","year":"2014","journal-title":"Ann Emerg Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1007\/s00247-016-3727-3","article-title":"Ultrasound, computed tomography or magnetic resonance imaging - which is preferred for acute appendicitis in children? A meta-analysis","volume":"47","author":"Zhang","year":"2017","journal-title":"Pediatr Radiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s13052-019-0726-7","article-title":"Possible cytokine biomarkers in pediatric acute appendicitis","volume":"45","author":"Stankovic","year":"2019","journal-title":"Ital J Pediatr."},{"key":"B13","doi-asserted-by":"publisher","first-page":"R97","DOI":"10.1186\/cc10104","article-title":"Association between serum soluble CD40 ligand levels and mortality in patients with severe sepsis","volume":"15","author":"Lorente","year":"2011","journal-title":"Crit Care."},{"key":"B14","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.jss.2011.01.047","article-title":"Diagnostic values of a single serum biomarker at different time points compared to Alvarado score and imaging examinations in pediatric appendicitis","volume":"174","author":"Wu","year":"2012","journal-title":"J Surg Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1001\/jama.282.11.1041","article-title":"Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children","volume":"282","author":"Garcia Pe\u00f1a","year":"1999","journal-title":"JAMA."},{"key":"B16","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1016\/j.amjsurg.2019.02.003","article-title":"The utility of CT scan for the diagnostic evaluation of acute abdominal pain","volume":"217","author":"Bax","year":"2019","journal-title":"Am J Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1001\/jamapediatrics.2017.0057","article-title":"Comparison of antibiotic therapy and appendectomy for acute uncomplicated appendicitis in children: a meta-analysis","volume":"171","author":"Huang","year":"2017","journal-title":"JAMA Pediatr."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1016\/j.jpedsurg.2007.02.010","article-title":"Predictive value of white blood cell count and C-reactive protein in children with appendicitis","volume":"42","author":"Beltr\u00e1n","year":"2007","journal-title":"J Pediatr Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1097\/PEC.0b013e31802d1716","article-title":"The use of white blood cell count and left shift in the diagnosis of appendicitis in children","volume":"23","author":"Wang","year":"2007","journal-title":"Pediatr Emerg Care."},{"key":"B20","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1258\/shorts.2011.011025","article-title":"Diagnostic accuracy of white cell count and C-reactive protein for assessing the severity of paediatric appendicitis","volume":"2","author":"Siddique","year":"2011","journal-title":"JRSM Short Rep."},{"key":"B21","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1111\/j.1553-2712.2011.01095.x","article-title":"Discriminative accuracy of novel and traditional biomarkers in children with suspected appendicitis adjusted for duration of abdominal pain","volume":"18","author":"Kharbanda","year":"2011","journal-title":"Acad Emerg Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1001\/jama.298.4.438","article-title":"Does this child have appendicitis?","volume":"298","author":"Bundy","year":"2007","journal-title":"JAMA."},{"key":"B23","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1097\/01.pec.0000142957.34501.8d","article-title":"Evidence-based approach to the diagnosis of appendicitis in children","volume":"20","author":"Kwok","year":"2004","journal-title":"Pediatr Emerg Care"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4103\/ajps.AJPS_47_16","article-title":"Role of laboratory markers in predicting severity of acute appendicitis","volume":"15","author":"Virmani","year":"2018","journal-title":"Afr J Paediatr Surg."},{"key":"B25","doi-asserted-by":"publisher","first-page":"e0148799","DOI":"10.1371\/journal.pone.0148799","article-title":"The use of delta neutrophil index and myeloperoxidase index for predicting acute complicated appendicitis in children","volume":"11","author":"Kim","year":"2016","journal-title":"PLoS ONE."},{"key":"B26","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1097\/PEC.0b013e318252d875","article-title":"C-reactive protein and procalcitonin are predictors of the severity of acute appendicitis in children","volume":"28","author":"Gavela","year":"2012","journal-title":"Pediatr Emerg Care."},{"key":"B27","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1007\/s00011-010-0213-5","article-title":"Soluble CD40L (CD154) is increased in patients with shock","volume":"59","author":"Chew","year":"2010","journal-title":"Inflamm Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"7497314","DOI":"10.1155\/2018\/7497314","article-title":"The CD40 rs1883832 polymorphism affects sepsis susceptibility and sCD40L levels","volume":"2018","author":"Liu","year":"2018","journal-title":"Biomed Res Int."},{"key":"B29","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1016\/j.bbrc.2015.06.153","article-title":"p62 regulates CD40-mediated NF\u03baB activation in macrophages through interaction with TRAF6","volume":"464","author":"Seibold","year":"2015","journal-title":"Biochem Biophys Res Commun."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1161\/ATVBAHA.112.248773","article-title":"Synergistic effect of thrombin and CD40 ligand on endothelial matrix metalloproteinase-10 expression and microparticle generation in vitro and in vivo","volume":"32","author":"Mart\u00ednez de Lizarrondo","year":"2012","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1080\/09540105.2019.1660623","article-title":"Glucocerebroside reduces endothelial progenitor cell-induced angiogenesis","volume":"30","author":"Lee","year":"2019","journal-title":"Food Agric Immunol."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.676370\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T05:33:51Z","timestamp":1623216831000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.676370\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,9]]},"references-count":31,"alternative-id":["10.3389\/fped.2021.676370"],"URL":"https:\/\/doi.org\/10.3389\/fped.2021.676370","relation":{},"ISSN":["2296-2360"],"issn-type":[{"type":"electronic","value":"2296-2360"}],"subject":[],"published":{"date-parts":[[2021,6,9]]},"article-number":"676370"}}