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Routine Biomarkers in Paediatric Appendicitis Stratification: Which Add Diagnostic Value? A Retrospective Cohort
Ciprian-Ioan Borca1,2, Alexandru Alexandru1, Madalin-Marius Margan3,4
1Doctoral School, Victor Babes University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
Children (Basel, Switzerland)
|May 4, 2026
Summary
Routine blood tests like C-reactive protein (CRP) and the systemic immune-inflammation index (SII) can help identify complicated paediatric appendicitis. Fibrinogen offers minimal additional value for severity stratification in these cases.
Area of Science:
- Pediatric Surgery
- Diagnostic Biomarkers
- Inflammatory Indices
Background:
- Preoperative differentiation between uncomplicated and complicated pediatric appendicitis is challenging.
- Routine biomarkers and blood cell count-derived inflammatory indices are evaluated for severity stratification.
- The study investigates the added predictive value of fibrinogen beyond commonly used markers.
Purpose of the Study:
- To evaluate the diagnostic performance of routine admission biomarkers and inflammatory indices for severity stratification in pediatric appendicitis.
- To determine if fibrinogen provides additional predictive value for complicated appendicitis.
- To assess the utility of C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) in distinguishing appendicitis severity.
Main Methods:
- Retrospective single-center study (2018-2025) of patients with suspected appendicitis.
- Inclusion of patients with complete admission laboratory data (CRP, fibrinogen, complete blood count).
- Evaluation of diagnostic discrimination and multivariable prediction models for severity stratification.
Main Results:
- Complicated appendicitis showed higher inflammatory markers and longer hospital stays (p < 0.001).
- CRP demonstrated the strongest univariable discrimination (AUC 0.785); fibrinogen showed lower performance (AUC 0.744).
- A combined model (CRP, NLR, SII) achieved good discrimination (AUC 0.812), with minimal improvement from fibrinogen (AUC 0.813). CRP and SII were independently associated with complicated appendicitis (p < 0.001).
Conclusions:
- Routine biomarkers and inflammatory indices can aid severity stratification in pediatric appendicitis.
- CRP and SII offer significant predictive information; fibrinogen provides limited additional value.
- A select set of routine laboratory markers may assist early risk stratification, pending external validation.
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