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Conventional inflammatory markers have limited accuracy, highlighting the potential value of composite inflammatory indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pediatric patients were categorized as having non-perforated or perforated appendicitis based on intraoperative findings and histopathologic confirmation. Laboratory data obtained on hospital admission included C-reactive protein (CRP), white blood cell count, and differential leukocyte percentages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The subjects of this retrospective study were 338 pediatric patients, 48 (14.2%) of whom had perforated AA. The CRP to lymphocyte ratio (CRP\/LR) was significantly higher in the patients with perforated AA (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). ROC analysis demonstrated good discriminative performance of CRP\/LR for predicting appendiceal perforation, with an area under the curve of 0.84 (95% CI 0.78\u20130.90). A CRP\/LR cut-off value of \u2265\u20097.2 yielded a sensitivity of 83.3% and a specificity of 78.6%. After adjustment for age, symptom duration, and body temperature on admission, CRP\/LR remained an independent predictor of appendiceal perforation in the multivariate regression analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The CRP\/LR showed good diagnostic performance in differentiating perforated from non-perforated AA and may serve as a simple, readily available tool for early risk stratification in pediatric patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00595-026-03345-6","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T07:37:59Z","timestamp":1779781079000},"page":"2024-2030","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["C-reactive protein-to-lymphocyte ratio and perforation in pediatric appendicitis"],"prefix":"10.1007","volume":"56","author":[{"given":"Zlatan","family":"Zvizdic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmir","family":"Jonuzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadja","family":"Zvizdic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9743-7265","authenticated-orcid":false,"given":"Semir","family":"Vranic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"issue":"1","key":"3345_CR1","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s13052-017-0335-2","volume":"43","author":"HH Almaramhy","year":"2017","unstructured":"Almaramhy HH. 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