[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-461661-105":59,"doc-detail-461661-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","clr-crp-to-lymphocytes-score-for-differentiating-simple-and-complicated-appendicitis-in-pediatric-patients","CLR (CRP to Lymphocytes) Score for Differentiating Simple and Complicated Appendicitis in Pediatric Patients","","Acute appendicitis in children requires distinguishing simple from complicated disease to guide timely management, yet conventional clinical scores and ultrasound can be insufficient. This retrospective study evaluates preoperative inflammation biomarkers—including NLR, MLR, PLR, NMR, NPR, PIV and CRP-to-lymphocytes ratio (CLR)—for separating simple appendicitis from complicated appendicitis. Among 878 pediatric patients undergoing appendectomy (2018–2024), complicated cases show higher inflammatory markers. CLR achieves the best diagnostic performance (AUC 0.772, sensitivity 78%, specificity 62.6%).",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/clr-crp-to-lymphocytes-score-for-differentiating-simple-and-complicated-appendicitis-in-pediatric-patients/461661/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/clr-crp-to-lymphocytes-score-for-differentiating-simple-and-complicated-appendicitis-in-pediatric-patients/461661.png","ImageObject",300,407,{"name":92,"@type":93},"hdkawk","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Which biomarkers were assessed to differentiate simple from complicated pediatric appendicitis?","Question",{"text":112,"@type":113},"The study evaluated neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-monocyte ratio (NMR), neutrophil-to-platelet ratio (NPR), pan-immune-inflammation value (PIV) ratio, and CRP-to-lymphocytes ratio (CLR).","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were patients classified as simple versus complicated appendicitis?",{"text":117,"@type":113},"Appendicitis was classified as simple (SA) or complicated (CA) using intraoperative findings during appendectomy.",{"name":119,"@type":110,"acceptedAnswer":120},"How well did CLR perform compared with other markers?",{"text":121,"@type":113},"CLR showed the highest diagnostic accuracy with AUC 0.772, sensitivity 78%, and specificity 62.6%, outperforming other evaluated biomarkers.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},461661,1790807751,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":41,"preview_page_count":4},3985747859855,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Article  \nCLR (CRP to Lymphocytes) Score for Differentiating Simple and Complicated Appendicitis in Pediatric Patients  \nAdir Alper 1, Ariel Galor 1, Mathias Lerner 1, Omer Levy 1 and Osnat Zmora 2, *  \nAcademic Editor: Sergio Huerta  \nReceived: 25 October 2025  \nRevised: 31 December 2025  \nAccepted: 2 January 2026  \nPublished: 5 January 2026  \nCopyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Shamir Medical Center, Be’er Ya’acov 60930, Israel; [alpera@nychhc.org](alpera@nychhc.org) (A.A.)  \n2 Department of Pediatric Surgery, Shamir Medical Center, Be’er Ya’acov 60930, Israel  \n* Correspondence: [osnatzm@shamir.gov.il](osnatzm@shamir.gov.il)  \nAbstract  \nBackground: Acute appendicitis, a frequent pediatric surgical emergency, requires distinguishing simple from complicated cases for treatment decisions. Current tools, such as clinical scores and ultrasound, are sometimes ineffective. This study evaluates the biomarkers: neutrophils to lymphocytes ratio (NLR), monocytes to lymphocytes ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophils to monocytes ratio (NMR), neutrophils to platelet ratio (NPR), pan-immune-inflammation value (PIV) ratio, and C-Reactive Protein (CRP) to lymphocytes ratio (CLR) for differentiation between simple and complicated appendicitis. Methods: A retrospective study of 878 pediatric patients (\u003C18 years) who underwent appendectomy (2018–2024) at a tertiary medical center, with appendicitis classified as simple (SA, n = 696) or complicated (CA, n = 182) using intraoperative findings. Biomarkers were calculated from preoperative blood counts and CRP. Diagnostic accuracy was assessed using Mann–Whitney U tests, ROC curves, and logarithmic regression. Results: Patients with CA had higher neutrophils counts (13.61 ± 4.92 vs. 11.39 ± 4.29 K/µL), monocytes counts (1.23 ± 1.41 vs. 0.95 ± 0.48 K/µL), platelet counts (294.31 ± 72.73 vs. 270.15 ± 72.08 K/µL), CRP levels (88.55 ± 97.75 vs. 27.15 ± 44.74 mg/L), and elevated biomarker ratios as compared to those with SA: NLR (≥10.15, OR = 2.45), MLR (≥0.645, OR = 2.78), PLR (≥224.38, OR = 2.502), NMR (≥6.38, OR = 2.34), NPR (≥0.0405, OR = 1.876), PIV (≥2433.85, OR = 3.348), and CLR (≥11.77, OR = 5.935), all at p \u003C 0.01 . CLR demonstrated the highest accuracy (AUC = 0.772, sensitivity 78%, specificity 62.6%), outperforming established biomarkers, followed by PIV (AUC = 0.679) . NPR was the least effective marker (AUC = 0.569) . Conclusions: CLR, a promising biomarker, can aid in distinguishing complicated from simple appendicitis in children, and may offer accessible tools for resource-limited settings.  \nKeywords: acute appendicitis; biomarkers; complicated appendicitis; CRP-to-lymphocyte ratio; CLR; NLR; PIV; MLR; PLR  \n1. Introduction  \nAcute appendicitis is the most common surgical emergency in children, characterized by inflammation of the appendix that can progress from simple (uncomplicated) inflammation to complicated forms involving gangrene and/or perforation with generalized peritonitis or abscess formation. Early and accurate classification of pediatric appendicitis into simple versus complicated is crucial as it directly influences treatment decisions and patient outcomes. Simple appendicitis may be managed conservatively with antibiotics  \nversus surgery within 24 h, while complicated appendicitis typically requires urgent surgical intervention and more intensive postoperative care for generalized peritonitis, as well as more prolonged intra-venous (IV) treatment and possible drainage for periappendicular abscesses. Misclassification or delayed diagnosis, especially in young children who often present with atypical symptoms, increases the risk of complications and associated morbidity [1,2] .  \nTraditional diagnostic approaches, including clinical scores, ultrasonography, computed tomography (","cbCairXHIr7DuMXE","https://ap.wps.com/l/cbCairXHIr7DuMXE","pdf",646769,12,"English","# Abstract\n# Introduction\n## Background and clinical need\n## Limitations of traditional diagnostic tools\n## Biomarkers and prior evidence","[{\"question\":\"Which biomarkers were assessed to differentiate simple from complicated pediatric appendicitis?\",\"answer\":\"The study evaluated neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-monocyte ratio (NMR), neutrophil-to-platelet ratio (NPR), pan-immune-inflammation value (PIV) ratio, and CRP-to-lymphocytes ratio (CLR).\"},{\"question\":\"How were patients classified as simple versus complicated appendicitis?\",\"answer\":\"Appendicitis was classified as simple (SA) or complicated (CA) using intraoperative findings during appendectomy.\"},{\"question\":\"How well did CLR perform compared with other markers?\",\"answer\":\"CLR showed the highest diagnostic accuracy with AUC 0.772, sensitivity 78%, and specificity 62.6%, outperforming other evaluated biomarkers.\"}]","CLR (CRP to Lymphocytes) Score for Differentiating Simple and Complicated Appendicitis in Pediatric Patients | PDF",1790762080]