Diagnostic accuracy of hyponatremia as a biomarker of perforated appendicitis in pediatrics in Dr. Soetomo General Hospital, Surabaya

Introduction: Acute appendicitis is the most common acute abdomen in pediatrics. The diagnosis is challenging because of the various symptoms and characteristics of children with difficulty expressing pain. This condition makes perforated appendicitis high in pediatrics. This study aimed to investigate the potential role of hyponatremia as a biochemical predictor of complicated appendicitis. Methods: An analytical-observational study in Soetomo General Hospital was performed from 2017-2021. The natrium level of patients, particularly those under 18 years of age diagnosed with appendicitis, was examined. Results: There were 102 pediatric patients with appendicitis. In this study, 32 subjects (31%) were diagnosed with acute appendicitis, and 70 (69%) had perforated appendicitis. It was found that there was a correlation between hyponatremia and appendicitis perforation, indicated by a sensitivity of 58.5% and specificity of 65.6%. The mean serum of natrium level in patients with perforated appendicitis, 131.1 ± 3.8 mEq/L, is lower than in patients with acute appendicitis, 136.6 ± 3.9 mEq/L. The prevalence risk value of patients diagnosed with perforated appendicitis and hyponatremia was approximately 2,69. The area under the ROC curve was 0.721, with a 95% confidence interval of 62.3% to 80.5%. With the cut-off natrium value set to ≤ 133 mEq/L, the sensitivity and specificity values were estimated at 50% and 81.25%, respectively. Conclusions: There was a correlation between hyponatremia and appendix perforation. Hyponatremia can be potentially used as a biomarker predictor in pediatric perforated appendicitis.