Lymphocyte-to-C-reactive Protein Ratio: a New Biomarker to Predict Perforation in Acute Appendicitis

The objective of this study is to examine the success of lymphocyte-to-C-reactive protein ratio (LCR) in the differentiation of acute appendicitis and perforated appendicitis. In this case series analysis, the data of patients who had operated with acute appendicitis between 2014 and 2020 were analyzed and histopathologically divided into two groups: acute appendicitis and perforated appendicitis. Age, gender, hospitalization period, white blood cell (WBC), neutrophil, lymphocyte (LYM), platelet (PLT), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), LCR, and Alvarado score values were analyzed statistically in both groups of patients. A total of 332 patients have been included in the study. Perforation was observed in 10.2% (n = 34), and no perforation was observed in 89.8% (n = 298) of the patients. WBC, PLT, NEU, LYM, CRP, NLR, PLR, and LCR values were significantly different in the perforated appendicitis group. In receiver operating characteristic analysis results, a value of ≤0.179 was observed for LCR, and a sensitivity of 79.4% and a specificity of 82.6% were observed for perforated appendicitis differentiation. NLR, PLR, and LCR were found significantly in univariate regression analysis. However, in multivariate analysis, only LCR, odds ratios (95% CI): 32.9 (10.6–101.7) (p <0.001) were significant. The low preoperative LCR in acute appendicitis can be used as a biomarker to help prediction of perforation. When LCR was ≤0.179 as a cut-off value, the best prediction values of sensitivity 79.4% and specificity 82.6% were observed. LCR in a univariate and multivariate analyses was a better predictor than NLR and PLR.