The role of C-reactive protein to lymphocyte ratio in the differentiation of acute and perforated appendicitis

BACKGROUND: This study aimed to investigate the superiority of C-reactive protein (CRP) lymphocyte ratio (CLR) in acute appendicitis (AA) and perforated appendicitis (PA) compared to routine laboratory parameters in patients where radiological tests were insufficient to clarify the diagnosis.
METHODS: In this cross-sectional and retrospective study, the patients were divided into two groups as PA and AA. Age, sex, length of hospital stay, leukocytes, neutrophil, lymphocyte, CRP, and CLR were recorded at the time of diagnosis. Regression analyses were performed for the parameters, which were found to be statistically significant in univariate analysis.
RESULTS: One hundred thirty-one patients were included in this study (111 patients in the AA group, and 20 patients in the PA group). Age (p=0.03), gender (p<0.001), length of hospital stay (p<0.001), CRP (p<0.001), NLR (p=0.004) and CLR (p<0.001) were significantly different between both groups. However, only CLR was found as a significant risk factor in PA cases (p=0.016). The ROC analysis showed the highest AUC value in CLR (0.83). The cut-off value for predicting PA was found 0.45.
CONCLUSION: This study provided that the CLR is an important parameter for the differentiation of AA and PA patients. Besides, it is a valuable predictor in the preoperative risk classification of these patients.

Akut ve perfore apandisit ayýrýmýnda C-reaktif protein lefosit oranýnýn rolü

AMAÇ: Bu çalýþmada, CRP lenfosit oranýnýn akut apandisit (AA) ve perfore apandisit (PA) ayrýmýnda radyolojik tetkiklerin tanýyý netleþtirmede yetersiz kaldýðý vakalarda rutin kullanýlan laboratuvar parametrelerine göre üstünlüðünü araþtýrmak amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Kesitsel ve ileriye yönelik olarak plananlanan bu çalýþmada hastalar perfore ve non-perfore akut apandisit olarak iki gruba ayrýldý. Her iki gruptaki hastalarýn yaþý, cinsiyeti, yatýþ süresi, taný anýndaki lökosit, nötrofil, lenfosit, C reaktif protein (CRP), lenfosit oraný (CLR) deðerleri kayýt altýna alýndý. Tek deðiþkenli analiz ile istatistiksel olarak anlamlý sonuçlar saptanan deðerler arasýnda regresyon analizleri yapýldý.
BULGULAR: Çalýþmaya 131 hasta alýndý (AA grubunda 111 hasta ve PA grubunda 20 hasta). Yaþ (p=0.03), cinsiyet (p<0.001), hastanede kalýþ süresi (p<0.001), CRP (p<0.001), NLR (p=0.004), CLR (p<0.001) deðerleri her iki grup arasýnda anlamlý olarak farklý tespit edildi. Ancak yapýlan regresyon analizinde sadece CLR anlamlý bir risk faktörü olarak bulundu (p=0.016). ROC analizinde CLR’de en yüksek AUC deðeri gösterildi (0.83). PA’nin kestirim deðeri 0.45 olarak bulundu.
TARTIÞMA: Bu çalýþma CLR’nin AA ve PA hastalarýnýn ayýrýmý için önemli bir parametre olduðunu gösterdi. Ayrýca, bu hastalarýn preoperatif risk sýnýflandýrmasýnda deðerli bir belirleyicidir.