Diagnostic accuracy of the c-reactive protein to albumin ratio for identifying complicated appendicitis in adults: a retrospective study.
- 1Department of Emergency Medicine, Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Turkey.
- 2Department of Emergency Medicine, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey. [email protected].
- 3Department of General Surgery, Samsun University, Samsun, Turkey.
Abstract
Background
Acute appendicitis (AA) is one of the most common causes of surgical abdominal emergency. Based on the hypothesis that the C-reactive protein (CRP) to albumin ratio can differentiate the diagnosis of uncomplicated and complicated AA, we aimed to investigate the diagnostic value of the CRP to albumin ratio in the diagnosis of complicated AA in adults.Methods
This study was a single-center retrospective. Patients who were admitted to the academic ED in Turkey, who were considered to have suspected AA based on clinical, laboratory, and imaging methods, evaluated by the general surgeon, admitted to the general surgery clinic, underwent laparoscopic or open surgery, and who did not meet the exclusion criteria were included in the study. A receiver operating characteristic (ROC) curve was constructed to differentiate between complicated and uncomplicated AA. Finally, sensitivity, specificity, likelihood ratios, and positive and negative predictive values were calculated.Results
The study population comprised 232 patients, meeting the inclusion criteria. Of these, 90 had complicated AA and 142 had uncomplicated AA. One hundred fifty-one (65.1%) patients were men and 81 (34.9%) women. The Alvarado score, CRP to albumin ratio, and computed tomography (CT) or ultrasonography (US) measurement cut-off values were calculated to predict complicated AA. The Area Under the Curve (AUC) value for the Alvarado score was 0.771, and the cut-off value for complicated AA was 6, exhibiting 72.2% (95% Confidence Interval (CI), 61.8-81.2) sensitivity and 53.5% (95% CI, 45.0-61.9) specificity. The AUC value for the CRP to albumin ratio was 0.962, and the cut-off value for complicated AA was 0.43, exhibiting 94.4% (95% CI, 87.5-98.2) sensitivity and 90.1% (95% CI, 84.0-94.5) specificity. The AUC value for CT or US measurement was 0.664, and the cut-off value for complicated AA was 9.5, exhibiting 63.3% (95% CI, 52.5-73.3) sensitivity and 83.1% (95% CI, 75.9-88.9) specificity.Conclusions
The CRP to albumin ratio appears to have high sensitivity and specificity in distinguishing complicated from uncomplicated AA. This suggests that the CRP-to-albumin ratio may be used to distinguish complicated from uncomplicated AA. To validate and apply our findings, testing across multiple centers and diverse cohorts is necessary.
Related
- Diagnostic value of C-reactive protein-to-lymphocyte ratio combined with ultrasound features for complicated appendicitis: a retrospective cohort study
- Blood biomarkers and penalized logistic regression for the prediction of complicated appendicitis in children: a retrospective cohort study
- Diagnostic accuracy of the appendicitis inflammatory response (AIR) score for acute appendicitis during pregnancy: A systematic review and diagnostic meta-analysis
- Clinical and Laboratory Prediction of Histopathologically Complicated Acute Appendicitis and Associated Surgical Outcomes: A Retrospective Cohort Study
- C-Reactive protein and the CALLY index for predicting complicated appendicitis: a retrospective cohort study of 5,428 patients.
BibTeX
@article{altuntas2026diagnostic,
title = {{Diagnostic accuracy of the c-reactive protein to albumin ratio for identifying complicated appendicitis in adults: a retrospective study.}},
author = {Gürkan Altuntaş and Mümin Murat Yazıcı and Gökhan Demiral},
journal = {BMC gastroenterology},
year = {2026},
month = aug,
doi = {10.1186/s12876-026-05197-3},
url = {https://europepmc.org/article/MED/42972243},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Diagnostic accuracy of the c-reactive protein to albumin ratio for identifying complicated appendicitis in adults: a retrospective study.
AU - Gürkan Altuntaş
AU - Mümin Murat Yazıcı
AU - Gökhan Demiral
PY - 2026
DA - 2026/08/06
JO - BMC gastroenterology
DO - 10.1186/s12876-026-05197-3
UR - https://europepmc.org/article/MED/42972243
AB - Background Acute appendicitis (AA) is one of the most common causes of surgical abdominal emergency. Based on the hypothesis that the C-reactive protein (CRP) to albumin ratio can differentiate the diagnosis of uncomplicated and complicated AA, we aimed to investigate the diagnostic value of the CRP to albumin ratio in the diagnosis of complicated AA in adults.Methods This study was a single-center retrospective. Patients who were admitted to the academic ED in Turkey, who were considered to have suspected AA based on clinical, laboratory, and imaging methods, evaluated by the general surgeon, admitted to the general surgery clinic, underwent laparoscopic or open surgery, and who did not meet the exclusion criteria were included in the study. A receiver operating characteristic (ROC) curve was constructed to differentiate between complicated and uncomplicated AA. Finally, sensitivity, specificity, likelihood ratios, and positive and negative predictive values were calculated.Results The study population comprised 232 patients, meeting the inclusion criteria. Of these, 90 had complicated AA and 142 had uncomplicated AA. One hundred fifty-one (65.1%) patients were men and 81 (34.9%) women. The Alvarado score, CRP to albumin ratio, and computed tomography (CT) or ultrasonography (US) measurement cut-off values were calculated to predict complicated AA. The Area Under the Curve (AUC) value for the Alvarado score was 0.771, and the cut-off value for complicated AA was 6, exhibiting 72.2% (95% Confidence Interval (CI), 61.8-81.2) sensitivity and 53.5% (95% CI, 45.0-61.9) specificity. The AUC value for the CRP to albumin ratio was 0.962, and the cut-off value for complicated AA was 0.43, exhibiting 94.4% (95% CI, 87.5-98.2) sensitivity and 90.1% (95% CI, 84.0-94.5) specificity. The AUC value for CT or US measurement was 0.664, and the cut-off value for complicated AA was 9.5, exhibiting 63.3% (95% CI, 52.5-73.3) sensitivity and 83.1% (95% CI, 75.9-88.9) specificity.Conclusions The CRP to albumin ratio appears to have high sensitivity and specificity in distinguishing complicated from uncomplicated AA. This suggests that the CRP-to-albumin ratio may be used to distinguish complicated from uncomplicated AA. To validate and apply our findings, testing across multiple centers and diverse cohorts is necessary.
SN - 1471-230X
ER -