The use of the ratio of C-reactive protein to albumin for the diagnosis of complicated appendicitis in children

Abstract Background: No reliably specific marker for complicated appendicitis has been identified. Serum C-reactive protein (CRP) increases and albumin (ALB) decreases in patients with inflammation and infection. C-reactive protein and albumin ratio (CRP/ALB ratio) has been found associated with neonatal septicemia, inflammatory bowel disease and pancreatitis. However, its value in the diagnosis of complicated appendicitis has not been studied. The aim of this study was to evaluate the value of CRP/ALB ratio for predicting complicated appendicitis in children.Methods: A retrospective study of 232 children with acute appendicitis was conducted with assessment of age, gender, weight, symptom duration, albumin and blood routine indexes. According to intraoperative findings and postoperative pathological results, patients were divided into the simple appendicitis group (127 cases) and complicated appendicitis group (105 cases). SPSS version 17 was used to analyse the data.Results: Of the 232 patients, 118 (50.9%) were male and 114 (49.1%) were female. The age range was 1 to 15 years, the mean age of the patients was 8.30 ± 3.25 years. The CRP/ALB ratio was higher in complicated appendicitis compared with simple appendicitis(p<0.05). Logistic regression analysis showed that mononuclear cell (MC), CRP, procalcitonin (PCT) and CRP/ALB ratio were independent risk factors for complicated appendicitis in children. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of CRP/ALB ratio was higher than MC, PCT and CRP (0.946 vs 0.619 vs 0.843 vs 0.906). CRP/ALB ratio >1.43 was found to be a significant marker in predicting complicated appendicitis with 91.4 % sensitivity and 90.6 % specificity. Compared with CRP/ALB ratio=<1.43, patients with CRP/ALB ratio >1.43 had a 102.22 times higher chance of complicated appendicitis (95% CI:41.322 - 252.874).Conclusion: The CRP/ALB ratio is a novel and promising indicator to predict complicated appendicitis in children before operation，which is easy-to-measure and repeatable. Therefore, CRP/ALB ratio can provide a reference for the choice of surgical treatment for acute appendicitis in children.

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Predictive Factors of Acute Complicated Appendicitis: A Retrospective Study

10.21203/rs.3.rs-855961/v1 ◽

2021 ◽

Author(s):

Sawako Hiroi ◽

Michinori Hamaoka ◽

Masashi Miguchi ◽

Toshihiro Misumi ◽

Yuji Yamamoto ◽

...

Keyword(s):

Predictive Factors ◽

Operating Characteristic ◽

Characteristic Curve ◽

Complicated Appendicitis ◽

Fluid Retention ◽

C Reactive Protein ◽

Reactive Protein ◽

Preoperative Prediction ◽

Uncomplicated Appendicitis ◽

Operating Characteristic Curve

Abstract Background: Complicated appendicitis is an indication for emergency surgery. Therefore, the predictive factors for appendicitis based on the patient background needs identification. Previously, factors predicting non-complicated and complicated appendicitis were reported. However, most of those reports were deemed unsuitable as a standard for emergency use, since those comprised too many items as predictors. We previously reported three items that preoperatively predicted complicated appendicitis (body temperature, C-reactive protein, and fluid retention around the appendix). In this study, we re-evaluated different cases to confirm the usefulness of these three items can for accurately predicting complicated appendicitis preoperatively. In addition, we compared the effectiveness of these predictor items with those reported by other researchers.Methods: We retrospectively evaluated 417 adult patients who underwent surgery for acute appendicitis between January 2013 and December 2019, and compared our predictor items with those used in previous reports on the preoperative prediction of complicated appendicitis (criteria A consisting of eight predictor items and criteria B consisting of seven predictor items). Results: The area under the receiver operating characteristic curve (AUC) for the sensitivity to diagnose complicated appendicitis according to our criteria, criteria A, and criteria B were 0.823, 0.839, and 0.856, respectively. The AUC of our criteria and criteria A were similar (P = 0.356); those of criteria A and B were also similar (P = 0.352). However, the AUC of criteria B was statistically higher than that of our criteria (P < 0.05).Conclusion: Diagnostic criteria B were statistically the best predictor items for characterizing complicated and uncomplicated appendicitis. However, like criteria A and B, the AUC of our criteria exceeded 0.8, and only involved three predictor items; therefore, they can be considered useful predictors.

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Utility of biomarkers in predicting complicated appendicitis: can immature granulocyte percentage and c-reactive protein be used?

Postgraduate Medicine ◽

10.1080/00325481.2021.1948306 ◽

2021 ◽

Author(s):

Ali Güngör ◽

Aytaç Göktuğ ◽

Muhammed Mustafa Güneylioğlu ◽

Raziye Merve Yaradılmış ◽

İlknur Bodur ◽

...

Keyword(s):

Complicated Appendicitis ◽

C Reactive Protein ◽

Reactive Protein ◽

Immature Granulocyte

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Preoperative C-reactive protein predicts the severity and likelihood of complications following appendicectomy

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13946184901722 ◽

2014 ◽

Vol 96 (5) ◽

pp. 369-372 ◽

Cited By ~ 8

Author(s):

JA Shelton ◽

JJS Brown ◽

JA Young

Keyword(s):

Length Of Stay ◽

Postoperative Complication ◽

Inflammatory Markers ◽

Diagnostic Laparoscopy ◽

Complicated Appendicitis ◽

C Reactive Protein ◽

Open Procedure ◽

Final Pathology ◽

Reactive Protein ◽

Discharge Letter

Introduction Diagnostic laparoscopy with appendicectomy (LA) has become the accepted method of investigation and treatment of appendicitis. However, concerns remain in cases of complicated appendicitis when many advocate conversion to an open procedure (LCOA) owing to the risk of complications. The aim of this study was to look for factors that could predict complications occurring in patients undergoing appendicectomy. Methods Data inclusive of all consecutive appendicectomies over a two-year period were retrieved from the computerised theatre database. Clinical details including admission inflammatory markers, complications, severity (final pathology) and length of stay were collected from the discharge letter. Readmissions were identified as those hospital identifiers had a second set of admission dates and/or a second discharge letter. Results During the 2-year study period, 517 appendicectomies were performed. Of these, 429 patients (83%) had LA and the remaining 88 (17%) had LCOA. The LA group had a mean age of 28 years (range: 2–86 years) and a mean C-reactive protein (CRP) level of 71mg/l (range: 0–480mg/l) while the LCOA group had a mean age of 46 years (range: 11–92 years) and a mean CRP level of 162mg/l (range: 3–404mg/l). These differences in age and CRP were significant (p<0.001). LA patients were less likely to have complications overall (22% vs 52%, p=0.015). Complications were independently more than twice as common with established inflammation with a CRP level of >150mg/l (p<0.05). Conclusions A high preoperative CRP level predicts an increased rate of postoperative complication due to established inflammation and/or infection. This raises the question of whether we should be offering primary open appendicectomies to patients with a CRP level of >150mg/l.

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Could C-Reactive Protein be a Potential Biomarker of Complicated Acute Appendicitis?

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490791402100603 ◽

2014 ◽

Vol 21 (6) ◽

pp. 354-360

Author(s):

Cy Lai ◽

Yk Leung ◽

Ca Graham

Keyword(s):

Hong Kong ◽

Acute Appendicitis ◽

Sensitivity And Specificity ◽

Complicated Appendicitis ◽

C Reactive Protein ◽

Lower Quadrant ◽

Right Lower Quadrant Pain ◽

Reactive Protein ◽

Potential Biomarker ◽

Clinical Records

Introduction The purpose of this study is to evaluate the diagnostic value of C-reactive protein (CRP) to identify complicated appendicitis (defined as perforation, abscess or gangrenous appendicitis) versus simple appendicitis. Methods A retrospective study was performed in the emergency department (ED) of Prince of Wales Hospital in the New Territories of Hong Kong. The clinical records of patients admitted to the surgical wards via the ED over 17 months were reviewed by a research assistant. We included all patients aged >13 years who had a provisional diagnosis of “acute appendicitis” or “right lower quadrant pain”. We excluded patients with pregnancy, previous appendicectomy, incomplete medical records or no CRP levels determined before operation and those who discharged themselves from hospital against medical advice after admission. The outcome of this study was the CRP level in relation to the presence of complicated appendicitis. ROC curve analysis was employed to identify the optimum cut-off level of CRP which had the best sensitivity and specificity to identify complicated appendicitis compared to simple appendicitis. Results Forty-two patients were diagnosed to have acute appendicitis, 31 of whom had complicated appendicitis. CRP level was higher in the group of complicated appendicitis (p<0.05). We identified an optimum cut-off value for CRP of 40.1 mg/L to discriminate between complicated and non-complicated appendicitis. The sensitivity and specificity of CRP to identify complicated appendicitis were 71.0% and 100% respectively at this cut-off level. Conclusion High CRP levels could possibly predict the diagnosis of complicated appendicitis and facilitate more appropriate surgical care. This finding needs to be confirmed in prospective and larger multicentre studies. (Hong Kong j.emerg.med. 2014;21:354-360)

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Perforation rate after a diagnosis of uncomplicated appendicitis on CT

BJS Open ◽

10.1093/bjsopen/zraa034 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

K Lastunen ◽

A Leppäniemi ◽

P Mentula

Keyword(s):

Acute Appendicitis ◽

Emergency Operation ◽

Patient Characteristics ◽

Complicated Appendicitis ◽

C Reactive Protein ◽

Perforation Rate ◽

Reactive Protein ◽

Hourly Rate ◽

Uncomplicated Appendicitis ◽

Uncomplicated Acute Appendicitis

Abstract Background Appendicectomy is a common emergency operation. The aim of this analysis was to study the effect of preoperative delay on disease progression, and whether a novel scoring system (Atema score) could be useful in predicting complicated appendicitis. Methods Patients with uncomplicated acute appendicitis on CT and who underwent appendicectomy in 2014–2015 were analysed for patient characteristics, preoperative delay and outcomes. Results Of 837 patients with uncomplicated appendicitis on CT, 187 (22.3 per cent) were found to have complicated appendicitis at surgery. The median time estimate for perforation was 25.4 h after CT, with an hourly rate of perforation of 2 per cent. Patients with an Atema score of 6 or less and those with no appendicolith on CT and a C-reactive protein level below 51 mg/l were the slowest to develop perforation, reaching a perforation rate of 5 per cent in 7.1 and 7.6 h respectively. Conclusion A substantial proportion of patients with uncomplicated acute appendicitis on CT have complicated appendicitis at surgery. However, in patients with no risk factors, surgery can be postponed safely for up to 7 h.

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International normalized ratio and serum C-reactive protein are feasible markers to predict complicated appendicitis

World Journal of Emergency Surgery ◽

10.1186/s13017-016-0081-6 ◽

2016 ◽

Vol 11 (1) ◽

Cited By ~ 2

Author(s):

Maru Kim ◽

Sung-Jeep Kim ◽

Hang Joo Cho

Keyword(s):

International Normalized Ratio ◽

Complicated Appendicitis ◽

C Reactive Protein ◽

Reactive Protein

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Mean Platelet Volume/Platelet Count Ratio as a Diagnostic Marker in Children with Acute Appendicitis

Journal of Dr Behcet Uz Children s Hospital ◽

10.5222/buchd.2021.72335 ◽

2021 ◽

Author(s):

İnanç Karakoyun ◽

Mustafa Onur Öztan

Keyword(s):

Platelet Count ◽

Acute Appendicitis ◽

Mean Platelet Volume ◽

Diagnostic Value ◽

Complicated Appendicitis ◽

C Reactive Protein ◽

Platelet Volume ◽

Reactive Protein ◽

Uncomplicated Appendicitis ◽

Wbc Count

Objective: The objective of this research was to evaluate the diagnostic value of mean platelet volume/platelet count (MPV/PC) ratio in pediatric acute appendicitis. Methods: This retrospective study included a total of 310 patients, 176 in the uncomplicated appendicitis group, 80 in the complicated appendicitis group, and 54 in the nonspecific abdominal pain (NSAP) group. C-reactive protein (CRP) level, white blood cell (WBC) count, absolute neutrophil count (ANC), MPV, PC, and MPV/PC ratio were compared between the groups. Results: WBC and ANC levels differed significantly between the groups (P<0.001 in all pairwise comparisons). CRP levels in the complicated appendicitis group were higher than in the NSAP and uncomplicated appendicitis groups (P<0.001 for both comparisons). There was a negative correlation between MPV and PC (r= -0.434, P<0.001). Both PC and MPV/PC ratio were able to distinguish cases of complicated appendicitis from NSAP (P=0.047 and P=0.045, respectively) and from cases of uncomplicated appendicitis (P=0.010 and P=0.045, respectively). Areas under the ROC curve for CRP, WBC, ANC, MPV, PC, and MPV/PC ratio were 0.640, 0.690, 0.727, 0.553, 0.541, and 0.546, respectively. Conclusion: According to the results of our study, MPV/PC ratio can be used in addition to the conventional markers to discriminate cases of complicated appendicitis.

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C -reactive protein and albumin ratio for the diagnosis of complicated appendicitis in children

10.21203/rs.2.18030/v2 ◽

2020 ◽

Author(s):

Wei Feng ◽

Qian-Yu Yang ◽

Xu-Feng Zhao ◽

Miao-Miao Li ◽

Hua-Lei Cui

Keyword(s):

Characteristic Curve ◽

Prognostic Score ◽

Area Under The Curve ◽

Complicated Appendicitis ◽

Symptom Duration ◽

Specific Marker ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein ◽

Independent Risk Factors

Abstract Background: No reliably specific marker for complicated appendicitis has been identified. Serum C-reactive protein (CRP) and albumin (ALB) ratio (CRP/ALB ratio) has been a new inflammation-based prognostic score which is associated with the severity of inflammation. However, its value in the diagnosis of complicated appendicitis has not been studied. The aim of this study was to evaluate the predictive value of CRP/ALB ratio for complicated appendicitis in children. Methods: A retrospective study of 232 children with acute appendicitis was conducted with assessment of age, gender, symptom duration, albumin and blood routine indexes on admission. According to intraoperative findings and postoperative pathological results, patients were divided into the simple appendicitis group (127 cases) and complicated appendicitis group (105 cases). SPSS version 17 was used to analyse the data. Results: Of the 232 patients, 118 (50.9%) were male and 114 (49.1%) were female. The CRP/ALB ratio was higher in complicated appendicitis compared with simple appendicitis (p<0.05). Logistic regression analysis showed that the higher levels of mononuclear cell count (MC), CRP, procalcitonin (PCT) and CRP/ALB ratio were independent risk factors for complicated appendicitis in children. Receiver operating characteristic curve analysis showed that the area under the curve of CRP/ALB ratio (0.946) was was bigger than MC (0.619), CRP (0.906) and PCT (0.843). CRP/ALB ratio >1.43 was found to be a significant marker in predicting complicatedappendicitis with 91.4% sensitivity and 90.6% specificity. Compared with CRP/ALB ratio =<1.43, patients with CRP/ALB ratio >1.43 had a 102.22 times higher chance of complicated appendicitis (95% CI: 41.322 - 252.874). Conclusion: Admission CRP/ALB ratio was significantly higher in children with acute complicated appendicitis. It is a novel but promising hematological marker that aids the differentiation of acute complicated and simple appendicitis.

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