Relationship of Prognostic Nutritional Index, HALP score and Inflammatory Markers with Clinical Outcomes in Children with Complicated Appendicitis

Yıl 2025, Cilt: 7 Sayı: 3, 578 - 83, 09.09.2025

Mustafa Tuşat , Sebahattin Memiş , Mehmet Semih Demirtaş

https://doi.org/10.37990/medr.1710855

https://izlik.org/JA98SN74HP

Öz

Aim: One of the most frequent diagnoses in children presenting with acute abdominal pain is acute appendicitis. This study aims to analyze the effectiveness of the biomarkers such as the Prognostic Nutrition Index (PNI), hemoglobin-albumin-lymphocyte-platelet (HALP) score, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in predicting complicated appendicitis in children who undergo surgery for acute appendicitis.
Material and Method: A total of 253 children who underwent surgery for acute appendicitis in our clinic between January 1, 2022, and October 1, 2024, and underwent surgery for acute appendicitis were included in our study.
Results: Among the cases, 81% (n=205) were classified in the non-complicated, while 19% (n=48) were in the complicated group. In our analysis, we found that the PNI (p=0.027) and HALP score (p=0.007) were considerably lower in the complicated appendicitis group, whereas the neutrophil-to-lymphocyte ratio (NLR) (p=0.003) and platelet-to-lymphocyte ratio (PLR) (p=0.008) were significantly higher. Correlation analysis revealed a meaningful positive association between PNI and HALP score, a mild unfavorable association between PNI and both PLR and NLR, a strong positive correlation between HALP score and both PLR and NLR and a mild positive relationship between NLR and PLR.
Conclusion: PNI, HALP score, NLR, and PLR values measured at the time of admission to the emergency services may serve as potential predictors in differentiating between complicated and non-complicated appendicitis.

Anahtar Kelimeler

Children , complicated appendicitis , prognostic nutritional index , hemoglobin-albumin-lymphocyte-platelet score , inflammatory markers

Etik Beyan

The research was ethically approved by Aksaray University Scientific Research Ethics Committee on November 21, 2024 with decision number 2024/135.

Kaynakça

• Ural DA, Karakaya AE, Güler AG, et al. Comparative analysis of the acute appendicitis management in children before and during the Coronavirus Disease-19 pandemic. KSU Medical Journal. 2023;18:120-5.
• Tang G, Zhang L, Xia L, et al. Preoperative in-hospital delay increases postoperative morbidity and mortality in patients with acute appendicitis: a meta-analysis. Int J Surg. 2025;111:1275-84.
• Espejo OJA, Mejía MEM, Guerrero LHU. Acute appendicitis: imaging findings and current approach to diagnostic images. Rev Colomb Radiol. 2014;25:3877-88.
• AlHarmi R. Association between complete blood count parameters and histologically proven acute appendicitis. Cir Cir. 2025;93:28-34.
• Quinlan GJ, Martin GS, Evans TW. Albumin: biochemical properties and therapeutic potential. Hepatology. 2005;41:1211-9.
• Schmid-Schönbein GW. Analysis of inflammation. Annu Rev Biomed Eng. 2006;8:93-131.
• Yan L, Nakamura T, Casadei-Gardini A, et al. Long-term and short-term prognostic value of the prognostic nutritional index in cancer: a narrative review. Ann Transl Med. 2021;9:1630.
• Ikeguchi M, Hanaki T, Kihara K-i, et al. Correlation of operative mortality and morbidity with preoperative C-reactive protein/albumin ratio, neutrophil/lymphocyte ratio, and prognostic nutritional index in patients undergoing emergent operations due to strangulation ileus. International Surgery. 2021;105:278-83.
• Demirtas MS, Memis S, Kocagozoglu SG. Evaluation of hemoglobin, albumin, lymphocyte, and platelet score, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio in pediatric patients with rotavirus enteritis. J Clin Pract Res. 2025;47:28-35.
• Erdal H, Gunaydin F. HALP score for chronic spontaneous urticaria: does it differ from healthy subjects?. J Exp Clin Med. 2023;40:677-80.
• Barut E, Araç S, Barut K, Tas M. Analysis of the relationship between histopathological findings of patients with acute appendicitis and laboratory and imaging results ın the emergency department. Dicle Med J. 2025;52:115-26.
• Ertekin B, Acar T. The association between acute appendicitis complications and hematological parameters-based indices. Ann Clin Anal Med. 2023;14:254-8.
• Balbaloğlu H. The effect of prognostic nutrition index (PNI) rates on the development of surgical site infection after abdominal surgery. Turk Hij Den Biyol Derg. 2024;81:45-52.
• Benli S, Tazeoğlu D. The efficacy of hemoglobin, albumin, lymphocytes, and platelets (HALP) score in signifying acute appendicitis severity and postoperative outcomes. Updates Surg. 2023;75:1197-202.
• Saridas A, Vural N, Duyan M, et al. Comparison of the ability of newly inflammatory markers to predict complicated appendicitis. Open Med. 2024;19:20241002.
• Kosidło JW, Wolszczak-Biedrzycka B, Matowicka-Karna J, et al. Clinical significance and diagnostic utility of NLR, LMR, PLR and SII in the course of COVID-19: a literature review. J Inflamm Res. 2023;16:539-62.
• Kumarasamy C, Sabarimurugan S, Madurantakam RM, et al. Prognostic significance of blood inflammatory biomarkers NLR, PLR, and LMR in cancer—A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2019;98:e14834.
• Babayiğit E, Akın F, Bakdık S, et al. The diagnostic role of ultrasonography and neutrophil-to-lymphocyte ratio in acute abdominal pain in children. Genel Tıp Derg. 2025;35:142-9.
• Siki FÖ, Sarıkaya M, Gunduz M, et al. Evaluation of the systemic immune inflammation index and the systemic inflammatory response index as new markers for the diagnosis of acute appendicitis in children. Ann Saudi Med. 2023;43:329-38.
• Suzuki T, Matsumoto A, Sugiki D, et al. Clinical prediction model for gangrenous appendicitis: a retrospective single-center study. Scand J Surg. 2025 Feb 20. doi: 10.1177/14574969251319853. [Epub ahead of print].
• Ayrık C, Karaaslan U, Dağ A, et al. Lökosit sayısı, yüzde nötrofil oranı ve C-reaktif protein konsantrasyonlarının “kesim değeri” düzeylerinde apandisit tanısındaki değerleri. Ulus Travma Acil Cerrahi Derg. 2016;22:76-83.
• Patel P, Walborn A, Rondina M, et al. Markers of inflammation and infection in sepsis and disseminated intravascular coagulation. Clin Appl Thromb Hemost. 2019;25:1076029619843338.
• Hernández-González LL, Serrano-Guzmán SJ, Guzmán-Ortiz JD, et al. C-reactive protein, international normalized ratio, and fibrinogen in diagnostic scale of complicated acute appendicitis. Clin Pract. 2025;15:25.
• Kim M, Kim S-J, Cho HJ. International normalized ratio and serum C-reactive protein are feasible markers to predict complicated appendicitis. World J Emerg Surg. 2016;11:31.