CLR (CRP to Lymphocytes) Score for Differentiating Simple and Complicated Appendicitis in Pediatric Patients

Area of Science:

• Pediatric Surgery
• Biomarker Discovery
• Inflammatory Markers

Background:

• Acute appendicitis is a common pediatric surgical emergency.
• Differentiating simple from complicated appendicitis is crucial for treatment.
• Existing diagnostic tools like clinical scores and ultrasound have limitations.

Purpose of the Study:

• To evaluate the efficacy of several inflammation-based biomarkers in differentiating simple appendicitis (SA) from complicated appendicitis (CA) in pediatric patients.
• To compare the diagnostic accuracy of neutrophils to lymphocytes ratio (NLR), monocytes to lymphocytes ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophils to monocytes ratio (NMR), neutrophils to platelet ratio (NPR), pan-immune-inflammation value (PIV) ratio, and C-Reactive Protein to lymphocytes ratio (CLR).

Main Methods:

• A retrospective analysis of 878 pediatric patients (<18 years) who underwent appendectomy.
• Appendicitis was classified as simple (SA) or complicated (CA) based on intraoperative findings.
• Preoperative blood counts and C-Reactive Protein (CRP) levels were used to calculate biomarker ratios; diagnostic accuracy was assessed using ROC curves.

Main Results:

• Patients with complicated appendicitis (CA) exhibited significantly higher neutrophil, monocyte, platelet counts, and CRP levels compared to simple appendicitis (SA).
• All evaluated biomarker ratios, including NLR, MLR, PLR, NMR, NPR, PIV, and CLR, were significantly elevated in CA patients (p < 0.01).
• The C-Reactive Protein to Lymphocytes Ratio (CLR) showed the highest diagnostic accuracy (AUC = 0.772), outperforming other biomarkers, followed by PIV (AUC = 0.679).

Conclusions:

• The CLR is a highly accurate and promising biomarker for distinguishing between simple and complicated appendicitis in the pediatric population.
• CLR offers a potentially valuable and accessible diagnostic aid, particularly beneficial in resource-limited healthcare settings.
• Further prospective studies are warranted to validate the clinical utility of CLR in pediatric appendicitis management.