Published: 2022-02-28

Role of C-reactive protein in enhancing the diagnosis of acute appendicitis

Raheel Hussan Naqvi, Abhinav Mani, Sahil Rometra, Gurbir Singh


Background: Acute appendicitis is one of the common surgical emergencies. This study analysed C- reactive protein as a diagnostic marker of acute appendicitis.

Objective of the current study was to investigate the efficacy of C-reactive protein in the diagnosis of acute appendicitis.

Methods: A prospective study done on patients coming to hospital with clinical diagnosis of acute appendicitis and underwent appendectomy. Operative and histopathological findings were compared and analyzed with C- reactive protein.

Results: A total of 100 patients were included in the study. CRP was more than 6mg/l in 89 patients, and out of 89 patients, 87 patients had histopathologically inflamed appendix and serum CRP estimation in diagnosis of acute appendicitis yield sensitivity of 90.6%, specificity of 50%, positive predictive value of 97.75% and negative predictive value of 18.2%.

Conclusions: CRP was raised in patients with acute appendicitis and it aids as a marker for diagnosing acute appendicitis and decreasing the rate of negative appendectomy.


Acute appendicitis, CRP, Histopathology

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Cusheiri A, Grace PA, Darzi A. Disorders of small intestine and vermiform appendix. Clinical Surgery. 2nd ed. UK: Blackwell Publishing Ltd; 2010:405.

Hoffmann J, Rasmussen OO. Aids in the diagnosis of acute appendicitis. Br J Surg. 1989;76:774-9.

John H, Neff U, Kelemen M. Appendicitis diagnosis today: clinical and ultrasonic deductions. World J Surg. 1993;17:243-9.

Jones PF. Suspected acute appendicitis: trends in management over 30 years. Br J Surg. 2001;88: 1570-7.

Lee SL, Walsh AJ, Ho HS. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg. 2001;136:556-1.

Fitz RH. Perforating inflammation of the vermiform appendix: with special reference to its early diagnosis and treatment. Am J Med Sci. 1886; 92:321-46.

Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiol. 1986;158:355-60.

Pearson RH. Ultrasonography for diagnosing appendicitis. Br Med J. 1988;297:309-10.

Walsh AJ. A sound approach to the diagnosis of acute appendicitis. Lancet. 1987;1:198-200.

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.

Mohammed AA, Daghman NA, Aboud SM, Oshibi HO: The diagnostic value of C-reactive protein, white blood cell count and neutrophil percentage in childhood appendicitis. Saudi Med J. 2004;25(9): 1212-5.

Davies AH, Bernau F, Salisbury A, Souter RG. C- reactive protein in right iliac fossa pain. J R Coll Surg Edinb. 1991;36:242-4.

Al-Abed YA, Alobaid N, Myint F. Diagnostic markers in acute appendicitis. American Journal of Surgery. 2015;209(6):1043-7.

Jones K, Peña AA, Dunn EL, Nadalo L, Mangram AJ. Are negative appendectomies still acceptable? Am J surg. 2004;188(6):748-54.

Ghimire R, Sharma A, Bohara S. Role of C-reactive protein in acute appendicitis. Kathmandu Univ Med J. 2016;54(2):130-3.

Asfar S, Safar H, Khoursheed M, Dashti H, Al-Bader A. Would measurement of C reactive protein reduces the rate of negative exploration for acute appendicitis?. J R Coll Surg Edinb. 2000;45:21-4.

Shakhatreh 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.