# A Retrospective Study on the Use of C-reactive Protein and Neutrophil-Lymphocyte Ratio as Predictive Markers to Prevent Unnecessary Appendicectomy

## TL;DR

This study shows that C-reactive protein is a better predictor of acute appendicitis in children than other markers, helping avoid unnecessary surgery.

## Contribution

The study validates CRP as a superior biomarker for acute appendicitis prediction in children compared to NLR and standard blood counts.

## Key findings

- CRP had the highest predictive value with an AUC of 0.712 for acute appendicitis.
- CRP outperformed NLR, neutrophil, and lymphocyte counts in predicting appendicitis.
- Using CRP alongside other markers can reduce unnecessary appendicectomy.

## Abstract

Background: Symptomatology of acute appendicitis is a common presentation in children and biochemical markers are often utilised to differentiate acute appendicitis from other pathologies. The aim of this study is to assess the utility of C-reactive protein (CRP) and neutrophil-lymphocyte ratio compared to standard biochemical markers in predicting acute appendicitis and preventing unnecessary appendicectomy.

Methods: This is a single-centre retrospective cohort study of paediatric patients <16 years who presented to Ipswich Hospital with symptomatology of acute appendicitis between January 2019 to January 2024. Five hundred ninety-three patients were screened against inclusion/exclusion criteria and 582 patients were available for analysis.

Results: The study identified CRP (OR 1.009), neutrophil-lymphocyte ratio (NLR) (OR 0.909), neutrophil count (OR 1.222), and lymphocyte count (OR 0.708) to be significant coefficients in predicting acute appendicitis following logistic regression analysis. CRP was found to be a superior predictor of acute appendicitis following receiver operating characteristic (ROC) analysis (area under the curve (AUC) 0.712, sensitivity 75.60%, specificity 61.48%, p<0.001) compared to NLR, neutrophil and lymphocyte count.

Conclusion: In this large study, we have validated the effectiveness of certain biomarkers as predictive markers for acute appendicitis in children, potentially reducing the risk of unnecessary appendicectomy. CRP is superior to NLR, neutrophil and lymphocyte count in predicting acute appendicitis. The use of CRP, in addition to other markers such as NLR, is valuable in preventing unnecessary appendicectomy.