• Nauman Ahmed Bolan Medical complex hospital, Quetta


Background: Delayed or wrong diagnosis of acute appendicitis in patients results in complications like perforation, gangrene, etc. which carries a significant amount of morbidity and mortality to the patients. Thus, timely diagnosis of acute appendicitis is crucial to prevent these complications. Recently, it was found that serum C-reactive protein (CRP) individually can be a useful marker, thus in resource limited settings (i.e., access to ultrasonography) simple laboratory investigation can be of extreme utility for the diagnosis of acute appendicitis. Current study aimed to ascertain and determine the role of C Reactive Protein (CRP) as a complementary test to decrease the rate of negative appendectomies in tertiary care hospitals of Pakistan. Methods: Using non-probability consecutive sampling, 112 patients with the initial diagnosis of acute appendicitis on history and clinical examination were enrolled. A blood sample was taken for serum level of CRP. Results: Mean age was 20.8±8.6 years and 51 (45.5 %) patients were males. Pathologic review revealed 100 cases (89.3%) of acute appendicitis, 4 patients (3.6%) had perforated appendix while 8 patients (7.1%) had normal appendix. Sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of C reactive protein >24 mg/lit taking histology as gold standard came out 25.9%, 100%, 100%, 9.4% and 31.25% respectively. Conclusion: It was concluded that CRP >48 mg/lit is an indication of perforated appendix and when the surgeon is in fix whether to go conservatively or apply some intervention, CRP can be a good diagnostic aidKeywords: Acute appendicitis; C Reactive Protein; Diagnostic accuracy; Perforated appendix


Crownover BK, Bepko JL. Appropriate and safe use of diagnostic imaging. Am Fam Physician 2013;87(7):494–501.

Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg 2013;100(3):322–9.

Kaya B, Sana B, Eris C, Karabulut K, Bat O, Kutanis R. The diagnostic value of D-dimer, procalcitonin and CRP in acute appendicitis. Int J Med Sci 2012;9(10):909–15.

Ng KC, Lai SW. Clinical analysis of the related factors in acute appendicitis. Yale J Biol Med 2002;75(1):41–5.

Bachoo P, Mahomed AA, Ninan GK, Youngson GG. Acute appendicitis: the continuing role for active observation. Pediatr Surg Int 2001;17(2-3):125–8.

Tehrani HY, Petros JG, Kumar RR, Chu Q. Markers of severe appendicitis. Am Surg 1999;65(5):453–5.

McGowan DR, Sims HM, Zia K, Uheba M, Shaikh IA. The value of biochemical markers in predicting a perforation in acute appendicitis. ANZ J Surg 2013;83(1-2):79–83.

Thirumallai S, Wijesuriya SR, Mitchell A, Delriviere L. Predictive value of C-reactive protein with Alvarado score in acute appendicitis. ANZ J Surg 2014;84(5):335–6.

Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med 2014;15(7):859–71.

Jangjoo A, Varasteh AR, Bahar MM, Meibodi NT, Aliakbarian M, Hoseininejad M, et al. Is C-reactive protein helpful for early diagnosis of acute appendicitis? Acta Chir Belg 2011;111(4):219–22.

Leeuwenburgh MM, Stockmann HB, Bouma WH, Houdijk AP, Verhagen MF, Vrouenraets B, et al. A simple clinical decision rule to rule out appendicitis in patients with nondiagnostic ultrasound results. Acad Emerg Med 2014;21(5):488–96.

Panagiotopoulou IG, Parashar D, Lin R, Antonowicz S, Wells AD, Bajwa FM, et al. The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications. Ann R Coll Surg Engl 2013;95(3):215–21.

Yetkin G, Basak M, Işgör A, Kebudi A, Akgun I. Can negative appendectomy rate be decreased by using spiral computed tomography without contrast material? Acta Chir Belg 2002;102(5):334–7.

Atema JJ, Gans SL, Beenen LF, Toorenvliet BR, Laurell H, Stoker J, et al. Accuracy of White Blood Cell Count and C-reactive Protein Levels Related to Duration of Symptoms in Patients Suspected of Acute Appendicitis. Acad Emerg Med 2015;22(9):1015–24.

Abbas MH, Choudhry MN, Hamza N, Ali B, Amin AA, Ammori BJ. Admission levels of serum amyloid a and procalcitonin are more predictive of the diagnosis of acute appendicitis compared with C-reactive protein. Surg Laparosc Endosc Percutan Tech 2014;24(6):488–94.

Teo AT, Lefter LP, Zarrouk AJ, Merrett ND. Institutional review of patients presenting with suspected appendicitis. ANZ J Surg 2015;85(6):420–4.

Al-Abed YA, Alobaid N, Myint F. Diagnostic markers in acute appendicitis. Am J Surg 2015;209(6):1043–7.

Aslam V, Hussain S, Khan MS, Khan SM, Ullah R. C-reactive protein and total leukocyte count in the diagnosis of acute appendicitis. Med Forum 2015;26(6):2–5.

Muzaffar N, Bhatti S. Diagnostic value of total leucocyte count and C-reactive protein in acute appendicitis. Pak J Med Health Sci 2014;8(3):508–9.

Lai CY, Leung YK, Graham CA. Could C-reactive protein be a potential biomarker of complicated acute appendicitis? Hong Kong J Emerg Med 2014;21(6):354–60.

Xharra S, Gashi-Luci L, Xharra K, Veselaj F, Bicaj B, Sada F, et al. Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis. World J Emerg Surg 2012;7(1):27.

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