Role of C reactive protein, hyperbilirubinemia and mean platelet volume in diagnosis of acute appendicitis and its correlation post operatively with histo-pathological examination

Authors

  • Tiwari Sachin Mahendra Department of General Surgery, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
  • Saurabh Agrawal Department of General Surgery, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20231965

Keywords:

Acute appendicitis, CRP, Hyperbilirubinemia, Mean platelet volume

Abstract

  1. Background: Acute appendicitis is one of the most common abdominal emergencies requiring emergency surgery. The diagnosis based on the onset of symptoms and physical examination. Therefore, inaccuracies caused by subjective interpretation are frequent. This raises the need for tests to help diagnose acute appendicitis and predict the severity of the condition. aim of the study to investigate whether mean platelet volume, C-reactive protein, and hyperbilirubinemia can be used as inflammatory markers for the diagnosis of acute appendicitis and its correlation with histopathological examination.

    Methods: we prospectively analyzed 60 patients who were full fulling the inclusion criteria patients analysed for CBC, LFT and CRP and underwent for appendicectomy (Laparoscopic/open). Per-operative diagnosis was confirmed by histopathological examination from November 2020 to November 2022.

    Results: patients with CRP level > 6 and hyperbilirubinemia patients most likely to have acute appendicitis. Mean CRP level was 13.21±4.0 and mean bilirubin level 1.04±0.29 in case of acute appendicitis. CRP, hyperbilirubinemia levels were significantly higher in cases of acute appendicitis (p<0.01) while MPV value was not found significant. All patients was confirmed with histopathology examination.

    Conclusions: Serum bilirubin level and CRP estimation, which is a simple, cheap, and easily available laboratory test, can be added to the routine investigations in the diagnosis and severity of acute appendicitis and help in decreasing negative appendicectomy rates, especially in low modified Alvarado score.

References

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

Hamilton Bailey’s “Emergency Surgeries”, 12th Ed. 1995;438-51.

Ramula M, Lakshmipathy N, Karthik A, Krishnamurthy A. A comprehensive study on the diagnostic value of quantitative C-reactive protein measurement of acute appendicitis. J Evol Med Dent Sci. 2016;5(69):4995-9.

Whiting JF, Green RM, Rosenbluth AB, Gollan JL. Tumor necrosis factor-alpha decreases hepatocyte bile salt uptake and mediates endotoxin-induced cholestasis. Hepatology. 1995;22:1273-8.

Kim JJY, Dobson BH, Ng CLH, Thong DW, Arthur T, Parker D. Can normal inflammatory markers rule out acute appendicitis? the reliability of biochemical investigations in diagnosis. ANZ J. Surg. 2020;90:1970-74.

Slotboom T, Hamminga JT, Hofker HS, Heineman E, and Haveman JW: Apple Study Group A and Laparoscopic Evaluation. The intraoperative motive for performing a laparoscopic appendectomy on a postoperative histologically proven normal appendix. Scand J Surg. 2014;103:245-48.

Adams HL and Jaunoo SS: Hyperbilirubinaemia in appendicitis: The diagnostic value for prediction of appendicitis and appendiceal perforation. Eur J Trauma Emerg Surg. 2016;42:249-52.

Pieper R, Kager L, Tidefeldt U. obstruction of the appendix vermiformis causing acute appendicitis: an experimental study in rabbits. Acta Chir Scand. 1982;148:63-72.

Jones PF. Suspected acute appendicitis: trends in management over 30 years. British 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;136:556-61.

Kim HC, Yang DM, Lee CM, Jin W, Nam DH, Song JY et al. Acute appendicitis: relationships between CT-determined severities and serum white blood cell counts and C-reactive protein levels. Br J Radiol. 2011;84(1008):1115-120.

Hyoung-Min M, Beom-Seok P, Duk-Jin M. Diagnostic Value of C-reactive Protein in Complicated Appendicitis. J Korean Soc Coloproctol. 2011;27(3):122-6.

Han-Ping W, Ching-Yuang L, Chin-Fu C, Yu-Jun C, Chin-Yi H. Predictive value of C-reactive protein at different cutoff levels in acute appendicitis. Am J Emergency Med. 2016;23:449-53.

Dal F, Cicek Y, Pekmezci S, Kocazeybek B, Tokman HB, Konukoglu D et al. Role of Alvarado score and biological indicators of C-reactive protein, procalcitonin, and neopterin in the diagnosis of acute appendicitis. Ulusal travma ve acil cerrahi dergisi. Turk J Trauma Emergency Surg. 2019;25(3):229-37.

Anil KB, Kalyan K, Rehman M. Perforation in acute appendicitis: Evaluation of hyperbilirubinemia and elevated C reactive protein as a predictive factor. IAIM. 2017;4:18-23.

Atahan K, Üreyen O, Aslan E. Preoperative diagnostic role of hyperbilirubinemia as a marker of appendix perforation. J Int Med Res. 2011;39:609-18.

Park Y, Schoene N, Harris W. Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets. 2002;13(5-6):301-6.

Ozdemir O, Soylu M, Alyan O, Geyik B, Demir AD, Aras D et al. Association between mean platelet volume and autonomic nervous system functions: Increased mean platelet volume reflects sympathetic overactivity. Exp Clin Cardiol. 2004;9(4):243-7.

Uyanik B, Kavalci C, Arslan ED, Yilmaz F, Aslan O, Dede S et al. Role of Mean Platelet Volume in Diagnosis of Childhood Acute Appendicitis. Emergency Med Int. 2012;2012:4.

Sartelli M, Viale P, Catena F. 2013 WSES guidelines for the management of intra-abdominal infections. World J Emerg Surg. 2013;8(1):3.

Yeaman Michael R. Bacterial-platelet interactions: virulence meets host defense. Future Microbiol. 2010;5(3):471-506.

Kapsoritakis AN, Koukourakis MI, Sfiridaki A, Potamianos SP, Kosmadaki MG, Koutroubakis IE et al. Mean platelet volume: a useful marker of inflammatory bowel disease activity. Am J Gastroenterol. 2001;96(3):776-81.

Kisacik B, Tufan A, Kalyoncu U, Karadag O, Akdogan A, Ozturk MA et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008;75(3):291-4.

Albayrak Y, Albayrak A, Albayrak F, Yildirim R, Aylu B, Uyanik A et al. Mean Platelet Volume: A New Predictor in Confirming Acute Appendicitis Diagnosis. Clin Appl Thrombosis/Hemostasis. 2011;17(4):362-66.

Downloads

Published

2023-06-28

Issue

Section

Original Research Articles