Akile Zengin1, Yusuf Murat Bağ2, Mehmet Zeki Öğüt3, Kutay Sağlam4

1 Department of Gastrointestinal Surgery, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
2Clinic of General Surgery, Ankara Training and Research Hospital, Ankara, Türkiye
3Clinic of General Surgery, Elazığ Fethi Sekin City Hospital, Elazığ, Türkiye
4Department of Gastrointestinal Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye


Objective: C-reactive protein (CRP) levels increase and albumin levels decrease in patients with inflammation. CRP/albumin ratio (CAR) is a new inflammation-associated prognostic indicator. The prognostic nutritional index (PNI) was described as a simple and neutral indicator of adverse outcomes not only in chronic diseases but also in acute conditions. The aim of this study was to investigate the clinical significance of the CAR and PNI value in differentiating complicated acute appendicitis (AA).

Material and Methods: We retrospectively examined the medical records of 187 patients with AA. Patients were divided into two groups according to pathological results [non-complicated (n= 161) and complicated (n= 26)]. Demographic, clinical, laboratory, and pathological data were examined and compared between the groups. Logistic regression analyses were performed to determine the independent predictors for complicated AA.

Results: Median age of the study group was 32 (23-41) years, and most of the patients were males (n= 101, 54%). Patients in the complicated AA group were significantly older compared to the patients in the non-complicated AA group [38 (32-49.5) years vs. 30 (22-41) years, p= 0.002]. The complicated AA group had significantly higher CAR level compared to the non-complicated AA group (p= 0.001). The length of hospital stay was significantly longer in the complicated AA group compared to the non-complicated AA group [2.5 (2-4.25) days vs. 1 (1-2) days, p< 0.001]. Other variables (including PNI) did not significantly differ between the groups. In univariate logistic regression analysis, only age was found to be a significant variable (OR= 1.045, 95% CI= 1.016-10.74, p= 0.002), but in multiple variate logistic regression analysis, no variable was found to be significant in predicting complicated AA.

Conclusion: We concluded that CAR and PNI value are not independent predictors of complicated AA.

Keywords: Appendectomy, nutrition, lymphocyte, CAR, PNI

Cite this article as: Zengin A, Bağ YM, Öğüt MZ, Sağlam K. The role of C-reactive protein/albumin ratio and prognostic nutritional index in the diagnosis of complicated acute appendicitis. Turk J Surg 2024; 40 (1): 54-58.


Ethics Committee Approval

This study was approved İnönü University Health Sciences Non-invasive Clinical Research Ethics Committee (Decision date: 18.05.2021, No: 2021/2097).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - AZ; Design - AZ, YMB; Supervision - KS; Data Collection and/or Processing - MZÖ; Analysis and/or Interpretation - YMB; Literature Search - AZ; Writing Manuscript - AZ, YMB, KS; Critical Reviews - KS, MZÖ.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.