The diagnostic value of total leucocytes count, C-reactive protein and total bilirubin in acute appendicitis: a prospective study


  • Hiren Judal Department of General Surgery, Banas Medical College and Research Institute, Palanpur, Gujarat, India
  • Vasant Ganatra Department of General Surgery, Banas Medical College and Research Institute, Palanpur, Gujarat, India
  • Prema ram Choudhary Department of Physiology, Banas Medical College and Research Institute, Palanpur, Gujarat, India



Appendicitis, Bilirubin, C-reactive protein, Nor-mal appendix, Perforated appendicitis, Total leucocytes count


Background: The diagnostic like history, clinical examination and prejudiced role of white cell count and C-reactive protein (CRP) in acute appendicitis has been studied widely but still remains controversial. Therefore, the purpose of this study was to evaluate the diagnostic value of CRP, Total leucocytes count, bilirubin levels individually in cases of acute appendicitis and its complications.

Methods: This randomized prospective study was conducted in department of Surgery and our surgical hospital, Palanpur Gujarat. Total included 50 cases of clinically and radiologically diagnosed of acute appendicitis. The diagnostic value of these markers was predicted for the all groups in terms of sensitivity, specificity, PPVs and NPVs using sensitivity analysis and the diagnostic accuracy assessed.

Results: Acute appendicitis is the most common in female predominance with age group of 20-29 years and <20 years. The Inflamed appendix was diagnosed in 35 (70%) patients, Gangrenous appendix in 5 (10%) patients and Perforated appendix 4 (8%) patients. Patients with Perforated appendicitis had higher total bilirubin, TLC and CRP levels as compared to patients with normal and inflamed appendix (p<0.001) or a normal appendix (p<0.001). The CRP has highest sensitivity and specificity (74%, 52%) followed by bilirubin (65%, 70%), WBC count (60.2%, 89.5%).

Conclusions: TLC, CPR and bilirubin can be helpful in the diagnosis and decision-making of patients with suspected acute appendicitis.


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