LETTER
Importance of Serum Amyloid A on the Diagnosis of Acute Appendicitis To the Editor: In a recent issue of Surgical Laparoscopy, Endoscopy & Percutaneous, we have read with great interest the article by Abbas et al1 entitled “Admission levels of serum amyloid A and procalcitonin are more predictive of the diagnosis of acute appendicitis compared with c-reactive protein.” The researchers have reported that the admission serum levels of serum amyloid A (SAA) and procalcitonin were of significantly higher predictive power for the diagnosis of acute appendicitis in adult patients than serum C-reactive protein. However, we think that some points should be discussed. SAA is an acute phase protein, which is synthesized primarily in the liver due to stimulation by proinflammatory cytokines such as tumor necrosis factora, interleukin-6 (IL-6), and IL-1.2 Several investigators suggested that certain diseases such as chronic infections, systemic lupus erythematosus, Hashimoto thyroiditis, familial Mediterranean fever, rheumatic disorders (ankylosing spondylitis, rheumatoid arthritis), cardiovascular diseases, acute pancreatitis, diabetes mellitus, major depression, several types of vasculitis, epilepsy, and psoriasis can influence SAA levels.2,3
TO THE
EDITOR
In addition to the above diseases, nonsteroidal anti-inflammatory drugs, corticosteroids, statins, and diseasemodifying antirheumatic drugs could affect SAA levels.4,5 Also, dietary food supplements such as omega-3 fatty acids, a linoleic acid, antioxidants (phytic acid, taurine, ascorbic acid), vitamin A, vitamin E, and polyunsaturated fatty acids can alter SAA levels.6,7 In this regard, without defining these contributing factors, interpreting the results seems problematic. Alcohol usage, smoking status, and body mass indices of participants are important to define for SAA measurement because of being other confounder factors. Therefore, these contributors have to be stated and a multivariate regression analysis could be applied to show whether these variables have an effect on SAA levels.8,9 In conclusion, clarifying above concerns will certainly provide clearer picture to the readers. Mehmet Agilli, Fevzi N. Aydin, Yasemin Gulcan Kurt, Tuncer Cayci,
MD* MDw MDz MDz
*Department of Biochemistry Agri Military Hospital, Agri wDepartment of Biochemistry Sirnak Military Hospital, Sirnak zDepartment of Medical Biochemistry Gulhane Military Medical Academy Ankara, Turkey
REFERENCES 1. Abbas MH, Choudhry MN, Hamza N, et al. Admission levels of serum amyloid
2.
3.
4.
5.
6.
7.
8.
9.
A and procalcitonin are more predictive of the diagnosis of acute appendicitis compared with C-reactive protein. Surg Laparosc Endosc Percutan Tech. 2014;24: 488–494. Ahmed MS, Jadhav AB, Hassan A, et al. Acute phase reactants as novel predictors of cardiovascular disease. ISRN Inflamm. 2012;2012:953461. DOI: 10.5402/2012/ 953461. Obici L, Raimondi S, Lavatelli F, et al. Susceptibility to AA amyloidosis in rheumatic diseases: a critical overview. Arthritis Rheum. 2009;61:1435–1440. Fushimi T, Takahashi Y, Kashima Y, et al. Severe protein losing enteropathy with intractable diarrhea due to systemic AA amyloidosis, successfully treated with corticosteroid and octreotide. Amyloid. 2005;12:48–53. Horiuchi Y, Hirayama S, Soda S, et al. Statin therapy reduces inflammatory markers in hypercholesterolemic patients with high baseline levels. J Atheroscler Thromb. 2010;17:722–729. Spreafico A, Millucci L, Ghezzi L, et al. Antioxidants inhibit SAA formation and pro-inflammatory cytokine release in a human cell model of alkaptonuria. Rheumatology (Oxford). 2013;52: 1667–1673. Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol. 2006;48:677–685. Al-Sieni AI, Al-Alawy AI, Al-Shehri ZS, et al. Serum amyloid-A protein and serum rheumatoid factor as serological surrogate markers for smoking risk factor in Saudi population. Pak J Pharm Sci. 2013;26:239–243. O’Brien KD, Chait A. Serum amyloid A: the “other” inflammatory protein. Curr Atheroscler Rep. 2006;8:62–68.
The authors declare no conflicts of interest.
Surg Laparosc Endosc Percutan Tech
Volume 25, Number 3, June 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.surgical-laparoscopy.com |
267
Importance of Serum Amyloid A on the Diagnosis of Acute Appendicitis To the Editor: In a recent issue of Surgical Laparoscopy, Endoscopy & Percutaneous, we have read with great interest the article by Abbas et al1 entitled “Admission levels of serum amyloid A and procalcitonin are more predictive of the diagnosis of acute appendicitis compared with c-reactive protein.” The researchers have reported that the admission serum levels of serum amyloid A (SAA) and procalcitonin were of significantly higher predictive power for the diagnosis of acute appendicitis in adult patients than serum C-reactive protein. However, we think that some points should be discussed. SAA is an acute phase protein, which is synthesized primarily in the liver due to stimulation by proinflammatory cytokines such as tumor necrosis factora, interleukin-6 (IL-6), and IL-1.2 Several investigators suggested that certain diseases such as chronic infections, systemic lupus erythematosus, Hashimoto thyroiditis, familial Mediterranean fever, rheumatic disorders (ankylosing spondylitis, rheumatoid arthritis), cardiovascular diseases, acute pancreatitis, diabetes mellitus, major depression, several types of vasculitis, epilepsy, and psoriasis can influence SAA levels.2,3
TO THE
EDITOR
In addition to the above diseases, nonsteroidal anti-inflammatory drugs, corticosteroids, statins, and diseasemodifying antirheumatic drugs could affect SAA levels.4,5 Also, dietary food supplements such as omega-3 fatty acids, a linoleic acid, antioxidants (phytic acid, taurine, ascorbic acid), vitamin A, vitamin E, and polyunsaturated fatty acids can alter SAA levels.6,7 In this regard, without defining these contributing factors, interpreting the results seems problematic. Alcohol usage, smoking status, and body mass indices of participants are important to define for SAA measurement because of being other confounder factors. Therefore, these contributors have to be stated and a multivariate regression analysis could be applied to show whether these variables have an effect on SAA levels.8,9 In conclusion, clarifying above concerns will certainly provide clearer picture to the readers. Mehmet Agilli, Fevzi N. Aydin, Yasemin Gulcan Kurt, Tuncer Cayci,
MD* MDw MDz MDz
*Department of Biochemistry Agri Military Hospital, Agri wDepartment of Biochemistry Sirnak Military Hospital, Sirnak zDepartment of Medical Biochemistry Gulhane Military Medical Academy Ankara, Turkey
REFERENCES 1. Abbas MH, Choudhry MN, Hamza N, et al. Admission levels of serum amyloid
2.
3.
4.
5.
6.
7.
8.
9.
A and procalcitonin are more predictive of the diagnosis of acute appendicitis compared with C-reactive protein. Surg Laparosc Endosc Percutan Tech. 2014;24: 488–494. Ahmed MS, Jadhav AB, Hassan A, et al. Acute phase reactants as novel predictors of cardiovascular disease. ISRN Inflamm. 2012;2012:953461. DOI: 10.5402/2012/ 953461. Obici L, Raimondi S, Lavatelli F, et al. Susceptibility to AA amyloidosis in rheumatic diseases: a critical overview. Arthritis Rheum. 2009;61:1435–1440. Fushimi T, Takahashi Y, Kashima Y, et al. Severe protein losing enteropathy with intractable diarrhea due to systemic AA amyloidosis, successfully treated with corticosteroid and octreotide. Amyloid. 2005;12:48–53. Horiuchi Y, Hirayama S, Soda S, et al. Statin therapy reduces inflammatory markers in hypercholesterolemic patients with high baseline levels. J Atheroscler Thromb. 2010;17:722–729. Spreafico A, Millucci L, Ghezzi L, et al. Antioxidants inhibit SAA formation and pro-inflammatory cytokine release in a human cell model of alkaptonuria. Rheumatology (Oxford). 2013;52: 1667–1673. Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol. 2006;48:677–685. Al-Sieni AI, Al-Alawy AI, Al-Shehri ZS, et al. Serum amyloid-A protein and serum rheumatoid factor as serological surrogate markers for smoking risk factor in Saudi population. Pak J Pharm Sci. 2013;26:239–243. O’Brien KD, Chait A. Serum amyloid A: the “other” inflammatory protein. Curr Atheroscler Rep. 2006;8:62–68.
The authors declare no conflicts of interest.
Surg Laparosc Endosc Percutan Tech
Volume 25, Number 3, June 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.surgical-laparoscopy.com |
267
![[A rare differential diagnosis of acute appendicitis].](/assets/img/hold.png)
