C -Reactive Protein, Leukocyte Count and Neutrophils: A Diagnostic Aid in Acute Appendicitis

Abstract

Background: Many clinical methods, scoring systems, radiological and laboratory investigations are used to diagnose and differentiate simple from complicated appendicitis. Proactive approach results in high rate of negative appendectomies and conservative approach results in increased rate of post-operative complications. The objective of this study was to evaluate the role of CRP, TLC and Neutrophil percentage in the diagnosis and differentiation of simple and complicated appendicitis.

Methodology: This cross sectional study was conducted at department of Surgery, Nishtar medical university/hospital, Multan from 1^st November, 2019 to 30^th April, 2021. Blood samples from patients were collected after admission, for CRP, TLC and Neutrophil percentage. Data were collected and analyzed through SPSS version 23. 

Results: A total of 320 patients more than 12 years of age, 168 (52.5%) male and 152 (47.5%) female with  1.10:1, were included in the study. Sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) of CRP were 90.6%, 80%, 96% and 61.5% for acute appendicitis and 96.7%, 80%, 98.3%, and 66.7% for perforated appendicitis respectively with p-value of <0.000. Sensitivity, specificity, PPV and NPV of TLC were 87.5%, 80%, 95.9% and 54.5% for acute and 93.3%, 90%, 99.1% and 52.9% for perforated appendicitis with p= <0.000. Sensitivity, specificity, PPV and NPV of Neutrophils, in acute and perforated appendicitis were 83.8%, 76.7%, 95%, and 46.9% versus 87.5%, 70%, 97.2%, 31.8% respectively with P-value < 0.000.

Conclusion: Sensitivity, specificity and PPV of CRP, TLC and Neutrophils increased with the severity of appendicitis. Combining the results of the above three markers increased the diagnostic accuracy.

Keywords: Acute appendicitis, CRP (C-reactive protein), TLC (Leukocyte count) and Neutrophils.