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

Early distinction between perforated and non-perforated acute appendicitis (AA) in children remains challenging. Conventional inflammatory markers have limited accuracy, highlighting the potential value of composite inflammatory indices.

Pediatric patients were categorized as having non-perforated or perforated appendicitis based on intraoperative findings and histopathologic confirmation. Laboratory data obtained on hospital admission included C-reactive protein (CRP), white blood cell count, and differential leukocyte percentages.

The subjects of this retrospective study were 338 pediatric patients, 48 (14.2%) of whom had perforated AA. The CRP to lymphocyte ratio (CRP/LR) was significantly higher in the patients with perforated AA (p < 0.001). ROC analysis demonstrated good discriminative performance of CRP/LR for predicting appendiceal perforation, with an area under the curve of 0.84 (95% CI 0.78-0.90). A CRP/LR cut-off value of ≥ 7.2 yielded a sensitivity of 83.3% and a specificity of 78.6%. After adjustment for age, symptom duration, and body temperature on admission, CRP/LR remained an independent predictor of appendiceal perforation in the multivariate regression analysis.

The CRP/LR showed good diagnostic performance in differentiating perforated from non-perforated AA and may serve as a simple, readily available tool for early risk stratification in pediatric patients.