C-reactive protein/albumin ratio greater than 7.1 is a good candidate to be used as an inflammation biomarker to predict perforation in appendicitis.

OBJECTIVE

We aimed at identifying novel biomarkers to predict perforation in patients with acute appendicitis.

PATIENTS AND METHODS

Medical records of patients who underwent appendectomy due to acute appendicitis were reviewed. Complete blood count and biochemistry panel results of these patients were analyzed. This study included 58 patients, 42 (72.4%) male and 16 (27.6%) female. The mean age of the patients was 33.8±14.1 years (range: 18-75). 49 (84.5%) patients had non-perforated acute appendicitis. Perforated acute appendicitis was observed in 9 (15.5%) patients.

RESULTS

Patients with perforated appendicitis had higher appendiceal diameter, C-reactive protein (CRP) level, CRP/albumin and monocyte/lymphocyte (M/L) compared to patients with non-perforated appendicitis. Moreover, patients with perforated appendicitis had lower lymphocyte count than those with no perforation. Sensitivity rates of appendiceal diameter, CRP level, CRP/Albumin and M/L for perforated appendicitis were similar (89%). However, the most specific biomarker for perforation was CRP/albumin (87.8%), followed by CRP (85.7%), M/L (63.3%) and appendiceal diameter (57.1%). Patients with CRP/albumin>7.1, CRP>32.7 mg/L, M/L>0.44 and appendiceal diameter>9.8 mm were most likely to have appendiceal perforation.

CONCLUSIONS

We suggest that CRP/albumin, CRP, M/L, appendiceal diameter and lymphocyte count can be used to predict perforation in patients with acute appendicitis. However, the most specific inflammation biomarker indicating perforated acute appendicitis is CRP/Albumin>7.1.