Levels of C-Reactive Protein and Sodium May Differentiate a Perforated Appendix from a Nonperforated Appendix in...

Area of Science:

• Pediatric Surgery
• Clinical Diagnostics
• Inflammatory Markers

Background:

• Acute appendicitis (AA) management varies, with conservative antibiotic treatment for AA and surgical intervention for perforated appendix (PA).
• Distinguishing between AA and PA is crucial for appropriate patient management.
• Clinical-laboratory markers may aid in differentiating these conditions.

Purpose of the Study:

• To evaluate the diagnostic value of clinical-laboratory markers in distinguishing between acute appendicitis and perforated appendix in pediatric patients.
• To identify key predictors for perforated appendix in children.

Main Methods:

• Retrospective analysis of preoperative parameters from 306 pediatric patients (<18 years) with histologically confirmed appendicitis (237 AA, 69 PA).
• Data collected between January 2014 and December 2017.
• Statistical analysis including discrimination and regression analysis.

Main Results:

• Perforated appendix was associated with male gender, younger age, lower sodium levels, and higher white blood cell count, Tzanakis score, C-reactive protein (CRP), and CRP-to-lymphocyte ratio (CLR).
• CLR and CRP demonstrated the highest accuracy in differentiating PA from AA.
• CRP, sodium levels, and Tzanakis score were identified as independent predictors for PA.

Conclusions:

• CRP-to-lymphocyte ratio (CLR), C-reactive protein (CRP), sodium levels, and Tzanakis score may assist in treatment decision-making for pediatric appendicitis.
• These markers can potentially improve the diagnostic accuracy in differentiating acute from perforated appendicitis.
• Further validation of these markers could refine management strategies for pediatric appendicitis.