Role of inflammatory and hematological markers in predicting the complicated and perforated acute appendicitis in pediatric population: A cohort study

INTRODUCTION: It is important to promptly assess the severity of appendicitis since late diagnosis can proceed towards perforation, peritonitis and sepsis. The main objective of this study is to decipher the ability of CRP, TLC and neutrophils in acute appendicitis to predict complications and perforation in pediatric age group. METHODS: This cohort study was conducted in the Pediatric Surgery Department of Liaquat National Hospital, Karachi. It included all the patients diagnosed and operated on for acute appendicitis within the pediatric age group. RESULTS: The median (IQR) age of study population was 9 (7–11) years, the majority of which fell into 6–12 years of age group with 70% males. Histopathology came out positive in 127 individuals. Out of those 127 patients, 45.9% (n = 62) had simple appendicitis and 48.1% (n = 65) had complicated appendicitis (n = 65), while 37 (27.4%) had shown perforation. The majority of individuals had suppurative appendicitis on histopathology (35.6%). On receiver operating characteristic (ROC) analysis, CRP has the highest specificity for complicated appendicitis and the highest positive likelihood ratio for both complicated and perforated appendicitis. CONCLUSION: CRP was observed in our study to be an independent marker of severity in acute appendicitis.