Abstract
Objective This study aimed to explore the laboratory markers associated with perforation in children with acute appendicitis. Methods This retrospective study reviewed 1895 children (3–18 years old) with confirmed acute appendicitis from 2007 to 2017. Clinical (demographic characteristics, symptoms, and signs) and laboratory data (white blood cell count, C-reactive protein (CRP), procalcitonin, D-lactate, platelet count, bilirubin, aspartate aminotransferase, and alanine aminotransferase) were collected and compared between perforated and nonperforated groups. The logistic regression analysis was performed to identify independent risk factors. Results Of all patients, 613 children were perforated. Children with perforation had significantly longer duration of symptoms, higher white blood cell count, CRP level, and neutrophils percentage, and lower serum sodium level. Elevated white blood cell count with CRP level and elevated neutrophils percentage with CRP level were found to be associated with risk of perforation. Conclusions White blood cell count with C-reactive protein and neutrophils percentage with CRP are important markers in distinguishing perforated appendicitis from nonperforated appendicitis in pediatric subjects.
Highlights
IntroductionIn Acute appendicitis (AA), about 30–75% of children progress to perforation, especially in children younger than 5 years [2]
Acute appendicitis (AA) is the most common surgery in children emergency [1]
Our results showed that elevated white blood cell count (>12000 mm3) with C-reactive protein (CRP) level (>8 mg/dL) and elevated neutrophils percentage (>74%) with CRP (>8 mg/dL) increased the odds of a perforated diagnosis of acute appendicitis
Summary
In AA, about 30–75% of children progress to perforation, especially in children younger than 5 years [2]. Previous studies have shown that children have higher rates of perforation compared with adults [3,4,5,6]. Delayed diagnosis and treatments often increase the risk of complications, such as perforation, abscess formation, peritonitis, and partial bowel obstruction. Erefore, identifying children at risk for perforated appendicitis is important since it decides further workup and management. The risk of perforation in pediatric appendicitis was reported to correlate with increased white blood cell count (WBC) and C-reactive protein (CRP) [10]. Poor correlation between WBC and appendiceal perforation was found in some studies [11, 12]
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