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.