The role of the C-reactive protein to lymphocyte ratio in the diagnosis of complicated acute appendicitis

OpenAlex İngilizce

BACKGROUND: To assess the diagnostic value of the C-reactive protein to lymphocyte ratio (CLR) and other inflammatory markers in distinguishing complicated from uncomplicated acute appendicitis (AA) to support timely surgical intervention. METHODS: This retrospective study included 682 patients who underwent appendectomy between January 2018 and January 2021. Based on the histopathological American Association for the Surgery of Trauma (AAST) AA grading system, patients were classified as complicated AA (grades 3-5; n=144) or uncomplicated AA (grades 1-2; n=538). Preoperative laboratory values-white blood cell (WBC) count, neutrophil count, C-reactive protein (CRP), sodium (Na), CLR, neutrophil-to-lymphocyte ratio (NLR), and CRP/Na-were analyzed. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. RESULTS: Complicated AA cases were significantly older (37.5+-17.6 vs. 30.0+-12.8 years; p<0.001). CRP (7.17+-6.78 vs. 2.98+-4.52 mg/dL), WBC, neutrophils, and CLR (5.66+-9.13 vs. 1.89+-3.94) were significantly elevated in the complicated group (p<0.001). CLR showed moderate diagnostic accuracy (AUC=0.712), with a cutoff of ≥2.82 yielding 53.5% sensitivity and 82.7% specificity (OR=5.49, 95% CI: 3.69-8.16). Hyponatremia and elevated NLR/PLR also correlated with complications. CONCLUSION: CLR is a moderately accurate, highly specific, and accessible biomarker for identifying complicated AA. Its integration with clinical evaluation may enhance preoperative risk stratification, especially in resource-limited settings.