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https://doi.org/10.14300/mnnc.2025.20021

Markers of netosis-mediated inflammatory response in peritoneal fluid as a criterion for the severity of appendicular peritonitis in children

[Original research] [Surgery]
Andrey Valerievich Pisklakov; Alexander Nikolaevich Zolotov; Dmitry Georgyevich Novikov; Veronika Sergeevna Rozdestvenskaya; Nikolay Aleksandrovich Kirichenko; Vyacheslav Ivanovich Ponomarev; Anatoly Vasilyevich Lysov; Vysotskaya Galina Ivanovna;

A study was conducted to assess the severity of neutrophil extracellular traps (NETs) formation in peritoneal fluid (PF) in children with appendicular peritonitis (AP). The study included 36 children mean age 10.6±3.2 with various forms of AP. They were divided into three equal groups based on disease duration: 1, 2, and 3 days, respectively. Peritoneal fluid samples were analyzed to quantify NETs, neutrophils, and early NETosis cells. The percentage of filamentous type neutrophil extracellular traps was significantly higher in the 3-day group compared to the 2-day and the 1-day groups (p=0.0295 and p=0.0001, respectively). Statistically significant differences in filamentous NET content were also observed between the 1-day and 3-day groups (p=0.0045). The number of filamentous NETs is the most sensitive marker, progressively increasing with disease duration. Quantifying the percentage of filamentous NETs allows identifying the stage of appendicular peritonitis. Neutrophil extracellular traps may serve as a key pathogenetic factor in appendicitis-related complications, requiring targeted therapy.

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Keywords: appendicitis, appendicular peritonitis, peritoneal fluid, neutrophil extracellular traps