Öz

 

 

Objective: Acute appendicitis (AA) is a leading cause of pediatric abdominal pain requiring surgical intervention. Differentiating simple appendicitis (SA) from complicated appendicitis (CA) preoperatively remains a clinical challenge. This study aimed to evaluate the diagnostic and prognostic utility of routinely available inflammatory markers—including C-reactive protein (CRP), fibrinogen, immature granulocyte (IG) count and percentage, neutrophil-to-lymphocyte ratio (NLR), and mean platelet volume (MPV)—in children with AA.

Material and Methods: This retrospective study included pediatric patients (<18 years) who underwent appendectomy for AA between January 2020 and December 2022. Patients were categorized as having SA or CA based on intraoperative and histopathological findings. Preoperative laboratory parameters were compared between groups. Spearman correlation and regression analyses were performed to assess associations with complication status and hospitalization duration.

Results: A total of 94 patients were included (mean age: 12.1±3.6 years; 63.8% male). CA was identified in 9 patients (9.6%). CRP levels were significantly higher in the CA group (p = 0.043) and independently predicted complications (OR: 1.018, 95% CI: 1.005–1.032, p =0.009). CRP was moderately correlated with both hospital stay (r =0.369, p <0.001) and fibrinogen levels (r =0.525, p <0.001). In multivariate linear regression, CRP remained a significant predictor of prolonged hospitalization (β =0.365, p =0.002), while fibrinogen did not. IG count, IG percentage, NLR, and MPV were not significantly associated with complication status or hospital stay.

Conclusion: CRP is a practical and reliable marker for predicting both complicated appendicitis and prolonged hospitalization in children. Fibrinogen is associated with disease burden but lacks independent predictive value. IG%, NLR, and MPV did not demonstrate clinical utility in this cohort. CRP may aid in preoperative risk stratification and postoperative care planning in pediatric AA.

Kaynakça

  1. Reynolds SL, Jaffe DM. Diagnosing abdominal pain in a pediatric emergency department. Pediatr Emerg Care. 1992;8(3):126-8. https://doi.org/10.1097/00006565-199206000-00003
  2. Magnúsdóttir MB, Róbertsson V, Þorgrímsson S, Rósmundssonet Þ, Agnarsson Ú, Haraldsson Á. Abdominal pain is a common and recurring problem in paediatric emergency departments. Acta Paediatr. 2019;108(10):1905-10. https://doi.org/10.1111/apa.14782
  3. Rentea RM, St Peter SD. Pediatric appendicitis. Surg Clin North Am. 2017;97(1):93-112. https://doi.org/10.1016/j.suc.2016.08.009
  4. Williams RF, Blakely ML, Fischer PE, Streck CJ, Dassinger MS, Gupta H, et al. Diagnosing ruptured appendicitis preoperatively in pediatric patients. J Am Coll Surg. 2009;208(5):819-25. https://doi.org/10.1016/j.jamcollsurg.2009.01.029
  5. Acharya A, Markar SR, Ni M, Hanna GB. Biomarkers of acute appendicitis: systematic review and cost-benefit trade-off analysis. Surg Endosc. 2017;31(3):1022-31.https://doi.org/10.1007/s00464-016-5109-1
  6. Beltrán MA, Almonacid J, Vicencio A, Gutiérrez J, Cruces KS, Cumsille MA. Predictive value of white blood cell count and C-reactive protein in children with appendicitis. J Pediatr Surg. 2007;42(7):1208-14. https://doi.org/10.1016/j.jpedsurg.2007.02.010
  7. Malia L, Sturm JJ, Smith SR, Brown RT, Campbell B, Chicaiza H. Predictors for acute appendicitis in children. Pediatr Emerg Care. 2019 May 24. https://doi.org/10.1097/PEC.0000000000001840
  8. Pavare J, Grope I, Gardovska D. Assessment of immature granulocytes percentage to predict severe bacterial infection in Latvian children: an analysis of secondary data. Medicina (Kaunas). 2018;54(4):56. https://doi.org/10.3390/medicina54040056
  9. Zeng L, Wang S, Lin M, Chen Y, Deng Q, Zhong H, et al. Evaluation of time to positivity for blood culture combined with immature granulocytes, neutrophil-to-lymphocyte ratio, and CRP in identifying bloodstream coagulase-negative Staphylococci infection in pediatric patients. J Clin Lab Anal. 2020;34(11):e23473. https://doi.org/10.1002/jcla.23473
  10. van der Geest PJ, Mohseni M, Brouwer R, Hoven B, Steyerberg EW, Groeneveld AB. Immature granulocytes predict microbial infection and its adverse sequelae in the intensive care unit. J Crit Care. 2014;29(4):523-7. https://doi.org/10.1016/j.jcrc.2014.03.033
  11. Shin DH, Cho YS, Cho GC, Ahn HC, Park SM, Lim SW, et al. Delta neutrophil index as an early predictor of acute appendicitis and acute complicated appendicitis in adults. World J Emerg Surg. 2017;12(1):32. https://doi.org/10.1186/s13017-017-0140-7
  12. Park JS, Kim JS, Kim YJ, Kim WY. Utility of the immature granulocyte percentage for diagnosing acute appendicitis among clinically suspected appendicitis in adults. J Clin Lab Anal. 2018;32(7):e22458.https://doi.org/10.1002/jcla.22458
  13. Maenhout TM, Marcelis L. Immature granulocyte count in peripheral blood by the Sysmex haematology XN series compared to microscopic differentiation. J Clin Pathol. 2014;67(7):648-50.https://doi.org/10.1136/jclinpath-2014-202223
  14. Beltran MA, Almonacid J, Vicencio A, Gutiérrez J, Cruces KS, Avendaño A. Predictive value of white blood cell count and C-reactive protein in children with appendicitis. J Am Coll Surg. 2007;205(1):69-73. https://doi.org/10.1016/j.jamcollsurg.2007.02.069
  15. Xharra S, Gashi Luci L, Xharra K, Veselaj F, Bicaj B, Sada F, et al. Correlation of serum C-reactive protein, white blood cell count and neutrophil percentage with histopathology findings in acute appendicitis. World J Emerg Surg. 2012;7:27. https://doi.org/10.1186/1749-7922-7-27
  16. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340(6):448-54. https://doi.org/10.1056/NEJM199902113400607
  17. Dinarello CA. The IL-1 family and inflammatory diseases. Clin Exp Rheumatol. 2002;20(5 Suppl 27):S1-13.
  18. Luyendyk JP, Schoenecker JG, Flick MJ. The multifaceted role of fibrinogen in tissue injury and inflammation. Blood. 2019 ;133(6):511-20. https://doi.org/10.1182/blood-2018-07-818211
  19. Alvarez-Alvarez FA, Maciel-Gutierrez VM, Rocha-Muñoz AD, Lujan JH, Ploneda-Valencia CF. Diagnostic value of serum fibrinogen as a predictive factor for complicated appendicitis (perforated). A cross-sectional study. Int J Surg. 2016;25:109-13. https://doi.org/10.1016/j.ijsu.2015.11.046
  20. Pavare J, Grope I, Gardovska D. Assessment of immature granulocytes percentage to predict severe bacterial infection in children: an analysis of secondary data. Medicina (Kaunas). 2018;54(4):56. https://doi.org/10.3390/medicina54040056
  21. Güngör A, Göktuğ A, Güneylioğlu MM, Yaradılmış RM, Bodur I, Öztürk B, Karaman İ, Karacan CD, Tuygun N. Utility of biomarkers in predicting complicated appendicitis: can immature granulocyte percentage and C-reactive protein be used? Postgrad Med. 2021;133(7):817-21. https://doi.org/10.1080/00325481.2021.1948306
  22. Eun S, Ho IG, Bae GE, Kim H, Koo CM, Kim MK, Yoon SH. Neutrophil-to-lymphocyte ratio for the diagnosis of pediatric acute appendicitis: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2021 N;25(22):7097-7107. doi: 10.26355/eurrev_202111_27263.
  23. Markar SR, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected appendicitis. Acta Chir Belg. 2010;110(5):543-547. https://doi.org/10.1080/00015458.2010.11680673
  24. Albayrak Y, Albayrak F, Albayrak A, Atcı M, Kabalar E, Üçbilek E. Mean platelet volume: a new predictor in confirming acute appendicitis diagnosis. Clin Appl Thromb Hemost. 2011;17(4):362-366. https://doi.org/10.1177/1076029610364520
  25. Yüksel D, Acar E, Öztürk G, Sezikli M, Altınay S, Altıntaş E, et al. The role of CRP and white blood cell in the diagnosis and follow-up of patients with acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2011;17(1):19-22. https://doi.org/10.5505/tjtes.2011.82195

Nasıl atıf yapılır

1.
Çatak Aİ, Cansaran S. C-reactive protein as a predictor of complication and hospital stay in pediatric appendicitis: Role of inflammatory biomarkers. Turk J Pediatr Dis. 2025;Early View:1-5. https://doi.org/10.12956/TJPD.2025.1171