Accuracy of C-reactive protein and leukocyte count in the diagnosis of acute appendicitis compared to histopathological examination

Abstract

Background. One of the most common causes of acute surgical abdomen is acute appendicitis. The aim of this study was to compare the accuracy of C-reactive protein (CRP) and the total leukocyte count (TLC) with the postoperative histopathological examination in the diagnosis of acute appendicitis. Methods. It is a prospective observational study over a period of 18 months, on patients who underwent emergency appendectomy. Purposive sampling method and Chi square test were used for the study to find significant association between the variables. Results. The mean age of the participants was 24.06 ± 8.61 years (74.7% men and 25.3% women). All cases had abdominal pain, and 86.7% anorexia, 57.3% migraine, 49.3% vomiting, 38.7% fever. In the case of the normal appendix, TLC was positive in 31% of cases; in cases with inflamed appendix 65% of cases were positive for TLC, while in cases with gangrenous and/or perforated appendix all cases were positive for TLC. CRP had a sensitivity of 88.7%, 69.23% specificity, 93.22% PPV and 56.25% NPV for diagnosis. When both TLC and CRP were used, they have a high sensitivity (90.32%) compared to single use and reported to histopathological findings, and a high PPV value (93.33%). Conclusions. The combined sensitivity and specificity values of TLC and CRP were higher in the diagnosis of acute appendicitis, thus reducing the number of negative appendicectomies and the need for a CT scan, which is generally expensive and associated with the risk of radiation.

Keywords

• c-reactive protein
• total leukocyte count
• appendicitis
• sensitivity
• appendicectomy
• histopathology