Novel Biomarkers for Improving the Diagnosis of Appendicitis in Pediatric Patients

Introduction: Diagnosing appendicitis in pediatric patients remains a clinical challenge, especially in resource-limited settings where imaging tools are less accessible. Inflammatory markers, including the Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Neutrophil-to-Monocyte Ratio (NMR), Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Platelet Ratio (NPR), and C-reactive protein (CRP), offer a promising approach to enhancing diagnostic accuracy. We aimed to evaluate the utility of these inflammatory markers to diagnose appendicitis. Methods: This retrospective study included 1027 pediatric patients who underwent appendectomy, with appendicitis confirmed histopathologically in 891 cases. Preoperative Inflammatory markers (NLR, MLR, NMR, PLR, NPR, and CRP) were analyzed and optimal cutoff values were determined using Receiver Operating Characteristic (ROC) curves. Results: Elevated NLR, NMR, PLR, NPR, and CRP were strongly associated with appendicitis, while an inverse relationship was observed with MLR. NLR (≥ 4.42) and NPR (≥ 0.0327) demonstrated high diagnostic accuracy with sensitivity and specificity exceeding 75%. Surprisingly, MLR showed a statistically significant inverse relationship with AA risk. Temperature differences between groups were not statistically significant. Conclusion: Each suggested novel inflammatory marker has the potential to improve the preoperative diagnosis of appendicitis in pediatric patients. Such a system could minimize reliance on imaging and expedite decision-making, especially in resource-constrained settings. Further prospective studies are needed to validate these findings and explore their clinical utility.