Diagnostic value of C-reactive protein-to-lymphocyte ratio combined with ultrasound features for complicated appendicitis: a retrospective cohort study
- 1Department of Ultrasonography, The First Hospital of Putian City, Nanmen West Road, Chengxiang District, Putian, People’s Republic of China
- 2Department of Medical Equipment Department, The First Hospital of Putian City, Putian, China
- 3Department of Anesthesiology, The First Hospital of Putian City, Nanmen West Road, Chengxiang District, Putian, People’s Republic of China
Abstract
Objective: To investigate the association between the C-reactive protein-to-lymphocyte ratio (CLR) and the risk of complicated appendicitis, and to evaluate its incremental diagnostic value over conventional ultrasound features.
Materials and methods: In this retrospective cohort study, 230 patients with ultrasound-diagnosed appendicitis between December 2021 and February 2024 were included. Complicated appendicitis was confirmed by postoperative pathology. Associations were assessed using logistic regression. The diagnostic performance of a model with five ultrasound features was compared to a model adding ln CLR using ROC curve analysis and the DeLong test.
Results: Among 230 patients, 34 (14.8%) were identified as having complicated appendicitis. Higher ln CLR showed an independent association with an increased risk, with an adjusted odds ratio of 2.54 (95% CI: 1.47–4.41, p = 0.001). Patients in the lowest CLR tertile appeared to have a higher adjusted odds compared with those in the highest tertile (OR = 5.14, 95% CI: 1.18–22.36, p = 0.029). The ultrasound-only model yielded an area under the curve (AUC) of 0.872 (95% CI: 0.816–0.928). The addition of ln CLR was associated with a modest improvement in diagnostic performance, with the AUC increasing to 0.911 (95% CI: 0.868–0.954, p = 0.047).
Conclusion: CLR may be independently associated with complicated appendicitis. The integration of CLR with ultrasound features appears to enhance diagnostic accuracy, suggesting that this combined approach could offer a practical tool for preoperative risk stratification.
Graphical Abstract:
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12876-026-05209-2.
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BibTeX
@article{lin2026diagnostic,
title = {{Diagnostic value of C-reactive protein-to-lymphocyte ratio combined with ultrasound features for complicated appendicitis: a retrospective cohort study}},
author = {Bixia Lin and Junfan Chen and Weide Lin and Meihua Chen},
journal = {BMC Gastroenterology},
year = {2026},
month = aug,
doi = {10.1186/s12876-026-05209-2},
url = {https://doi.org/10.1186/s12876-026-05209-2},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Diagnostic value of C-reactive protein-to-lymphocyte ratio combined with ultrasound features for complicated appendicitis: a retrospective cohort study
AU - Bixia Lin
AU - Junfan Chen
AU - Weide Lin
AU - Meihua Chen
PY - 2026
DA - 2026/08/08
JO - BMC Gastroenterology
DO - 10.1186/s12876-026-05209-2
UR - https://doi.org/10.1186/s12876-026-05209-2
AB - Objective: To investigate the association between the C-reactive protein-to-lymphocyte ratio (CLR) and the risk of complicated appendicitis, and to evaluate its incremental diagnostic value over conventional ultrasound features. Materials and methods: In this retrospective cohort study, 230 patients with ultrasound-diagnosed appendicitis between December 2021 and February 2024 were included. Complicated appendicitis was confirmed by postoperative pathology. Associations were assessed using logistic regression. The diagnostic performance of a model with five ultrasound features was compared to a model adding ln CLR using ROC curve analysis and the DeLong test. Results: Among 230 patients, 34 (14.8%) were identified as having complicated appendicitis. Higher ln CLR showed an independent association with an increased risk, with an adjusted odds ratio of 2.54 (95% CI: 1.47–4.41, p = 0.001). Patients in the lowest CLR tertile appeared to have a higher adjusted odds compared with those in the highest tertile (OR = 5.14, 95% CI: 1.18–22.36, p = 0.029). The ultrasound-only model yielded an area under the curve (AUC) of 0.872 (95% CI: 0.816–0.928). The addition of ln CLR was associated with a modest improvement in diagnostic performance, with the AUC increasing to 0.911 (95% CI: 0.868–0.954, p = 0.047). Conclusion: CLR may be independently associated with complicated appendicitis. The integration of CLR with ultrasound features appears to enhance diagnostic accuracy, suggesting that this combined approach could offer a practical tool for preoperative risk stratification. Graphical Abstract: Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12876-026-05209-2.
SN - 1471-230X
ER -