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Observational Study
. 2020 Oct 15;10(1):17352.
doi: 10.1038/s41598-020-73798-3.

An observational study of innate immune responses in patients with acute appendicitis

Toon Peeters  1   2   3   4 , Sandrina Martens  1   2   5 , Valentino D'Onofrio  1   2   3   4 , Mark H T Stappers  3   6 , Jeroen C H van der Hilst  1   2 , Bert Houben  7 , Ruth Achten  8 , Leo A B Joosten  3   9   4 , Inge C Gyssens  10   11   12   13
Affiliations
Observational Study

An observational study of innate immune responses in patients with acute appendicitis

Toon Peeters et al. Sci Rep. .

Abstract

Acute appendicitis is a common surgical emergency worldwide. Exaggerated immune responses could be associated with appendicitis. This study aimed at characterizing immune responses towards a large variety of gut commensals and pathogens, and pattern recognition receptor (PRR) ligands, and investigating the course of systemic inflammation in a prospective cohort of acute appendicitis patients. PBMC responses of 23 patients of the cohort and 23 healthy controls were characterized more than 8 months post-surgery. Serum cytokine levels were measured in 23 patients at the time of appendicitis and after one month. CRP, WBC and percentage of neutrophils were analyzed in the total cohort of 325 patients. No differences in PBMC responses were found between patients and controls. Stronger IL-10 responses were found following complicated appendicitis. A trend towards lower IL-8 responses was shown following gangrenous appendicitis. Serum IL-10 and IL-6 were significantly elevated at presentation, and IL-6, IL-8 and TNF-α levels were higher in complicated appendicitis. Routine biomarkers could predict severity of appendicitis with high specificities, but low sensitivities. Cytokine responses in patients following acute appendicitis did not differ from healthy controls. Higher serum cytokine levels were found in acute complicated and gangrenous cases. Further research into discriminative biomarkers is warranted.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flowchart of recruitment and sampling from patients with a history of acute appendicitis and healthy controls.
Figure 2
Figure 2
Cytokine responses towards commensal gut bacteria, pathogens and PRR agonists. (a, b) IL-6 and IL-8 responses in patients (n = 23) and controls (n = 23). (c) IL-10 responses in patients with a history of complicated (n = 16) and uncomplicated (n = 7) appendicitis. (d) IL-8 responses in patients with a history of non-gangrenous (n = 16) and gangrenous (n = 7) appendicitis. Whiskers indicate 10–90 percentile.
Figure 2
Figure 2
Cytokine responses towards commensal gut bacteria, pathogens and PRR agonists. (a, b) IL-6 and IL-8 responses in patients (n = 23) and controls (n = 23). (c) IL-10 responses in patients with a history of complicated (n = 16) and uncomplicated (n = 7) appendicitis. (d) IL-8 responses in patients with a history of non-gangrenous (n = 16) and gangrenous (n = 7) appendicitis. Whiskers indicate 10–90 percentile.
Figure 3
Figure 3
Serum cytokine concentrations in patients at the time of appendicitis and after one month of follow-up. T1 = Time point one, time of appendicitis (n = 23), T2 = Time point 2, one month of follow-up (n = 17).
Figure 4
Figure 4
Serum cytokine levels in patients with uncomplicated (n = 16) and complicated (n = 7) appendicitis.
Figure 5
Figure 5
Routine biomarkers according to severity in the total cohort matched for age and gender. (a) Uncomplicated (n = 95) versus Complicated (n = 95) according to ICD-9. (b) Non-Gangrenous (n = 97) versus Gangrenous (n = 97) according to pathology. Bars indicate mean with SEM.
Figure 5
Figure 5
Routine biomarkers according to severity in the total cohort matched for age and gender. (a) Uncomplicated (n = 95) versus Complicated (n = 95) according to ICD-9. (b) Non-Gangrenous (n = 97) versus Gangrenous (n = 97) according to pathology. Bars indicate mean with SEM.
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