THE ROLE OF WHITE CELL COUNT AND C-REACTIVE PROTEIN IN THE DIAGNOSIS OF ACUTE APPENDICITIS
Abstract
Background: Despite recent advances in diagnostic medicine, the diagnosis of appendicitis is still doubtful in a number of cases. Majority of the clinicians rely on their clinical examination strengthened by the laboratory tests. This study was carried out to find out the specificity and sensitivity of white cell count (WCC) and C-Reactive Protein (CRP) in diagnosing appendicitis in patients presenting with right iliac fossa pain. Methods: A total of 259 patients were included in this study that presented in the hospital with acute right iliac fossa pain and later on operated and had appendicectomy. The histopathology data was collected to find out the frequency of negative appendicectomy. According to the histopathology reports these patients were grouped into three sub-groups as normal appendix, inflamed appendix or perforated/gangrenous appendix. A record was kept of the WCC and CRP levels of these patients on admission. Results: A total of 259 patients were included in this study and out of them 37 had a normal appendix giving an over all negative appendicectomy rate of 14.3%. Out of these 11 were male and 26 were female, male to female ratio being 1:2.3. The age range was 12-73 with a median age of 24. Among the 222 patients who had appendicitis, 96 had a ruptured /perforated appendix and 126 had an inflamed appendix. Over all the WCC was elevated in 185 patients and CRP was elevated in 168 cases. The cut off value for white cell count was 11 x 106 / L. The C reactive protein levels were calculated by immunoturbidimetric test and the cut off value was taken as 1.7mg/dl. The sensitivity and specificity of WCC in this study was 83% and 62.1 % and that for CRP was 75.6% and 83.7 %. Conclusion: Both the inflammatory markers i.e. WCC and C-reactive protein can be helpful in the diagnosis, when measured together as this increases their positive predictive value.Key words: appendicitis, white cell count, C reactive proteinReferences
Pal K, Khan A. Appendicitis: a continuing challenge. J Pak Med Assoc 1998;48(7):189-92.
Abbassi A, Shah Y. Acute appendicitis in children. J Surg Pakistan 1998;2:28-30
Davenport M. Acute abdominal pain in children. BMJ 1996;312(7029):498-501
Delic J, Savkovic A, Isakovic E. Variations in the position and point of origin of vermiform appendix. Med Arch 2002;56(1):5-8.
Anderson R , Hugander A , Ghazi S , Ravan H , Offenbartl S, Nystron P et al. Diagnostic value of disease history, clinical presentation and inflammatory parameters of appendicitis. World J Surg 1999;23(2):133-40.
Eryilmaz R, Sahin M, Amlimoglu O, Bas G, Ozkan O. The value of C reactive protein and leukocyte count in preventing negative appendicectomies. Ulus Travma Derg 2001;7(3):142-5.
Andeson R, Lambe M, Reinhold B. Fertility pattern after appendectomy: Historical Cohort study BMJ 1999;18:963-7.
Peltokallio P, Tykka H. Evaluation of the age distribution and mortality of acute appendicitis. Arch Surg 1981;116: 153-6.
Ellis W. Acute Appendicitis: In Hamilton Bailey’s Emergency Surgery. 12th ed. Oxford. Butterworth Heinemann, 1995;411-23.
Khalid K, Ahmed N, Farooq, Anjum I, Sial G. Acute Appendicitis-laboratory dependence can be misleading: audit of 211 cases. J Coll Physicians Surg Pak 2001;11(7):434-7.
Rodriguez S, Martin P, Seco I, Garcia C, Naranjo A. C reactive protein and leukocyte count in the diagnosis of acute appendicitis in children. Dis Colon Rectum 1999;42(10):1325-9.
Gronroos J, Gronroos P. A fertile aged woman with right lower abdominal pain but unelevated leukocyte count and C reactive protein. Acute appendicitis is very unlikely. Langenbecks Arch Surg 1990; 384(5):437-40.
Malik K, Khan A, Waheed A. Evaluation of Alvarado Score in the diagnosis of Acute Appendicitis. J Coll Physicians Surg Pak 2000;10:392-4.
Eriksson S, Josephson T, Styrud J. A high degree of accuracy is possible in the diagnosis of appendicitis. Laboratory tests, ultrasonography and computerized tomography are of great value. Lakartidningen 1999;96(25):3058-61.
Zeidan B, Wasser T, Nicholas G. Ultrasonography in the diagnosis of appendicitis. J R Coll Surg Edinb 1997;42(1):24-6.
Caldwell M, Watson R. Peritoneal aspiration cytology as a diagnostic aid in acute appendicitis. Br J Surg 1994;81:276-8.
Coleman C, Thompson J, Bennion R, Schmit P. White Blood Cell count is a poor predictor of severity of disease in diagnosis of appendicitis. Am Surg 1998;64(10):983-5.
Thomson M, Underwood M, Dookeran K, Lloyd D, Bell P. Role of sequential leukocyte count and CRP measurements in acute appendicitis. Br J Surg 1992; 79(8):822-4.
Goodman D, Goodman C, Monk J. Use of neutrophil: lymphocyte ratio in the diagnosis of appendicitis. Am Surg 1995;61(3):257-9.
Clyne B, Olshaker J. The C Reactive Protein. J Emerg Med 1999;17(6):1019-25.
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