ArticleSurgery today2026
C-reactive protein-to-lymphocyte ratio and perforation in pediatric appendicitis.
Article in Surgery today, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeEarly 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.
methodsPediatric 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.
resultsThe 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.
conclusionThe 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.
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