Can C-Reactive Protein and White Blood Cell Count Predict Complicated Appendicitis in Children?

Acute appendicitis remains a challenging diagnosis in pediatrics, and inflammatory markers are helpful in the management of these patients. Our purpose is to evaluate the prediction potential of specific laboratory parameters (total white blood cell count and C-reactive protein) regarding complicated appendicitis and to highlight the need for a careful interpretation of their levels. A retrospective study was performed on a population of children who underwent appendectomy between January and December 2014. Patients were clustered in 2 groups according to severity of disease: group I, uncomplicated appendicitis; and group II, complicated appendicitis. Data regarding total white blood cell count and C-reactive protein levels were obtained. Variables were compared using χ2, Student t-tests, and Pearson correlation. A total of 128 pediatric patients (age <18 years) with a mean age of 10.2 ± 3.9 years were included (76 males). Complicated appendicitis occurred in 27 patients. Age of patient was statistically different in groups I (10.6 ± 3.8 years) and II (8.5 ± 3.7 years; P = 0.011). CRP is a parameter statistically correlated to severity of appendicitis (P < 0.001), but white blood cell count is not (P = 0.295). A CRP level (above 4.3 mg/dL) was 74% sensitive and 77% specific for complicated appendicitis. The authors emphasize the role of CRP value in the prediction of the severity of appendicitis in children and present a potential usable cutoff value of 4.3 mg/dL, as a marker of complicated appendicitis.