A Retrospective Study on the Use of C-reactive Protein and Neutrophil-Lymphocyte Ratio as Predictive Markers to Prevent Unnecessary Appendicectomy

Symptomatology of acute appendicitis is a common presentation in children and biochemical markers are often utilised to differentiate acute appendicitis from other pathologies. The aim of this study is to assess the utility of C-reactive protein (CRP) and neutrophil-lymphocyte ratio compared to standard biochemical markers in predicting acute appendicitis and preventing unnecessary appendicectomy.

This is a single-centre retrospective cohort study of paediatric patients <16 years who presented to Ipswich Hospital with symptomatology of acute appendicitis between January 2019 to January 2024. Five hundred ninety-three patients were screened against inclusion/exclusion criteria and 582 patients were available for analysis.

The study identified CRP (OR 1.009), neutrophil-lymphocyte ratio (NLR) (OR 0.909), neutrophil count (OR 1.222), and lymphocyte count (OR 0.708) to be significant coefficients in predicting acute appendicitis following logistic regression analysis. CRP was found to be a superior predictor of acute appendicitis following receiver operating characteristic (ROC) analysis (area under the curve (AUC) 0.712, sensitivity 75.60%, specificity 61.48%, p<0.001) compared to NLR, neutrophil and lymphocyte count.

In this large study, we have validated the effectiveness of certain biomarkers as predictive markers for acute appendicitis in children, potentially reducing the risk of unnecessary appendicectomy. CRP is superior to NLR, neutrophil and lymphocyte count in predicting acute appendicitis. The use of CRP, in addition to other markers such as NLR, is valuable in preventing unnecessary appendicectomy.