Evaluation of Serum C-reactive Protein in Acute Appendicitis and its Correlation with Histopathology

ABSTRACT

Introduction: Acute appendicitis is the most common abdominal surgical emergency. Despite extraordinary advances in radiographic imaging and diagnostic laboratory investigations, the diagnosis of acute appendicitis remains an enigmatic challenge in this modern era. The wide range of causes and varied patient presentations pose a formidable diagnostic and therapeutic dispute. Appendicectomy is the most common cause of acute surgical abdomen with a lifetime risk of 7%.[1] Classic clinical and laboratory findings usually allow for prompt diagnosis and treatment. Materials and Methods: In a prospective study, 100 patients clinically diagnosed as acute appendicitis were selected by purposive sampling method and evaluated as per criteria for serum c-reactive protein (CRP) levels and leukocyte count preoperatively and were followed up postoperatively with histopathology reports. The data were analyzed for finding the significance of serum CRP in the diagnosis of acute appendicitis. Results: CRP was positive in 75 of 77 patients who had histologically proven acute appendicitis and in 3 with normal appendix. The sensitivity, specificity, and diagnostic accuracy were 97.4%, 86.96%, and 95%, respectively. Leukocytosis and neutrophilia when used alone were not specific for acute appendicitis, but when combined with CRP value, diagnostic accuracy was high. Ultrasonography was useful in establishing alternative diagnoses but had low sensitivity for acute appendicitis. Conclusions: CRP contains important diagnostic information and hence should always be included in the diagnostic workup of acute appendicitis. Since acute appendicitis is very unlikely in those patients with normal white blood cell count and CRP value, conservative treatment is advised.