DOI: http://dx.doi.org/10.18203/2349-2902.isj20191903

Diagnostic value of C-reactive protein as a predictor of complicated appendicitis like perforated/gangrenous appendicitis

Suresh Kumar Choudhary, Bhanwar Lal Yadav, Shalu Gupta, Narender Kumar, Somendra Bansal, Pradeep Kumar Verma

Abstract


Background: Appendicitis is inflammation of appendix. Appendicitis remains the most common abdominal surgical emergency. There is no reliable specific marker for acute appendicitis and its complications. C- reactive protein is an acute phase reactant produced by the liver during the acute inflammation, which rises rapidly in presence of inflammation. CRP is a more sensitive and reliable indicator of inflammatory processes than ESR and leucocyte count. The aim of this study was to evaluate whether CRP predict the severity of appendicitis.

Methods: This study was hospital based, observational study. After history and clinical examination, patient underwent USG whole abdomen. Diagnosis of appendicitis was established. After that patient underwent routine blood investigations including, CRP. After confirming diagnosis of appendicitis, patients underwent appendectomy and biopsy of appendix was sent for histopathological examination.

Results: In our study, CRP value > 6.15mg/L has a sensitivity of 100.0% and a specificity of 54% in predicting complicated perforated or gangrenous appendicitis. The positive predictive value and negative predictive value of CRP were 100% and 61.54%  respectively. The cut off level at around 6mg/dL needs to be handled carefully and a person with high CRP should undergo surgery immediately.

Conclusions: This study clearly suggested that CRP leads to precise prediction of the severity of acute appendicitis for treatment. A person with high CRP should undergo surgery immediately ures.


Keywords


C- reactive protein, Inflammation, Perforated/gangrenous appendicitis

Full Text:

PDF

References


Stephens PL, Mazzucco JJ. Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis. Conn Med. 1999;63:137-40.

Jaffehe BM, Berger DH. The Appendix. In: Brunicardi FC, Anderson DK, Billiar TR, Dunn DL, Hunter JG, Pollock RE. Schwartz’s Principle of Surgery, New York: McGraw-Hill; 2005:1119-1138.

Shakhatresh HS. The accuracy of C- reactive protein in the diagnosis of acute appendicitis compared with that of clinical diagnosis. Med Arh. 2000;54(2):109-10.

Asfar S, Safar H, Khoursheed M, Dashti H, Al-Bader A. Would measurement of c-reactive protein reduce the rate of negative exploration for acute appendicitis? JR Coll Surg Edin. 2000;45(1):21-4.

Zimmerman MA, Selzman CH, Cothren C, Sorensen AC, Raeburn CD, Harken AH. Diagnostic implications of C-reactive protein. Arch Surg. 2003;138:220-4.

Ghag GS, Shukla KS, Shukla DKB, Bhalerao UD. A comparative study of perforated and non-perforated appendicitis with respect to clinical findings, radiological findings and post-operative management. Asian Pac. J Heal Sci. 2016;3(4S):5-13.

Dey S, Mohanta PK, Baruah AK, Kharga B, Bhutua KL, Singh VK. Alvarado scoring in acute appendicitis-a clinic-pathological correlation. Indian J Surg. 2010;72:290-3.

Jawaid A, Asad A, Motiei, Munir A, Bhutto E, Choudry H, et al. Clinical scoring system: a valuable tool-for decision making in cases of acute appendicitis. J P Ak Med Assoc. 1999;49:254-9.

Baidya N, Rodrigues G, Rao A, Khan SA. Evaluation of Alvarado score in acute appendicitis: a prospective study. The Internet J Surg. 2007;9:1-3.

Chan MY, Teo BS, Ng BL. The Alvarado score and acute appendicitis. Ann Acad Med Singapore. 2001;30:510-2.

Khan I, Rehman A. Application of Alvarado scoring in diagnosis in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2005;17:41-4.

Gurleyik E, Gurleyik G, Unalmiser S. Accuracy of serum C-reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression. Dis Colon Rectum. 1995;38(12):1270-4.

Kyriakidis AV, Alexandris I, Papoulia E, Athanasiou1 K, Perysinakis I, Pyrgioti1 M, et al. C-reactive protein: diagnostic aid in right lower quadrant abdominal pain. Annals Gastroenterol. 2010,23(4):307-10.

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.

Tarlekar S, Jain A, Raghuvanshi K. Role of C- reactive protein in addition of Alvarado score as a diagnostic toll in diagnosing acute appendicitis. SAS J Surg. 2016 Jan-Feb;2(1):40-45.

Ahmed n. C-reactive protein: an aid for diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2017;29(2):250-3.