C-reactive protein-to-lymphocyte ratio and perforation in pediatric appendicitis

Area of Science:

• Pediatric Surgery
• Inflammatory Markers
• Diagnostic Accuracy

Background:

• Distinguishing perforated from non-perforated acute appendicitis (AA) in children is clinically challenging.
• Conventional inflammatory markers often lack sufficient accuracy for early diagnosis.
• Composite inflammatory indices may offer improved diagnostic value.

Purpose of the Study:

• To evaluate the diagnostic performance of the C-reactive protein to lymphocyte ratio (CRP/LR) in differentiating perforated from non-perforated acute appendicitis in pediatric patients.
• To assess the utility of CRP/LR as a simple, readily available tool for early risk stratification.

Main Methods:

• Retrospective analysis of 338 pediatric patients with acute appendicitis.
• Categorization into non-perforated and perforated groups based on intraoperative and histopathologic findings.
• Measurement of C-reactive protein (CRP), white blood cell count, and differential leukocyte percentages on admission.

Main Results:

• Perforated AA was present in 14.2% of patients (48/338).
• The CRP/LR was significantly higher in patients with perforated appendicitis (p < 0.001).
• Receiver operating characteristic (ROC) analysis showed an area under the curve of 0.84 for CRP/LR, with a cut-off of ≥7.2 yielding 83.3% sensitivity and 78.6% specificity.
• CRP/LR was an independent predictor of perforation in multivariate analysis.

Conclusions:

• The CRP/LR demonstrates good diagnostic performance for differentiating perforated from non-perforated acute appendicitis in children.
• CRP/LR can serve as a simple and accessible biomarker for early risk stratification in pediatric appendicitis.
• This index may help clinicians identify children requiring urgent surgical intervention for perforated appendicitis.