Abstract
Aims and Objectives
- To analyze the diagnostic value of WBC count, C REACTIVE PROTEIN and PROCALCITONIN in acute appendicitis.
- To determine the WBC count, C reactive protein and Procalcitonin values in Acute appendicitis.
- To evaluate sensitivity, specificity, positive predictive value,negative predictive value of WBC count, C reactive protein, Procalcitonin in acute appendicitis.
Materials and Methods: A sample of 42 patients were selected using universal sampling and a prospective study was conducted. The patients with right iliac fossa pain and symptoms of acute appendicitis at the department of General surgery of Sri Siddhartha Medical College Hospital and research Centre from September 2018 to April 2020. Then the sample is subjected to WBC count, CRP, Procalcitonin levels and Histopathological report. Then the sensitivity, specificity, PPV and NPV of the above mentioned parameters are assessed.
Conclusion: We found that elevated serum CRP, Procalcitonin levels and WBC support the surgeon’s clinical diagnosis. We recommend CRP and procalcitonin measurement as a routine laboratory test in patients with suspected diagnosis of acute appendicitis. And we suggest that patients with lower abdominal pain and not clinically convincing and in the absence of increased inflammatory markers to undergo further imaging.
References
- Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-25.
- Schellekens DH, Hulsewe KW, van Acker BA, van Bijnen AA, de Jaegere TM, Sastrowijoto SH, et al. Evaluation of the diagnostic accuracy of plasma markers for early diagnosis in patients suspected for acute appendicitis. Acad Emerg Med. 2013;20(7):703-10.
- Smink DS, Finkelstein JA, Garcia Pena BM, ShannonMW, Taylor GA, Fishman SJ.Diagnosis of acute appendicitis in children using a clinical practice guideline. J Pediatr Surg. 2004;39(3):458-63.
- Humes DJ, Simpson J. Clinical Presentation of Acute Appendicitis: Clinical Signs–Laboratory Findings–Clinical Scores, Alvarado Score and Derivate Scores. In: Keyzer C, Gevenois PA, editors. Imaging of Acute Appendicitis in Adults and Children. Berlin, Heidelberg: Springer Berlin Heidelberg; 2012. p. 13-21.
- Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC. Systematic review andmeta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg. 2013;100(3):322-9.
- Bulent Kaya, Baris Sana, Cengiz Eris, Koray Karabulut, Orhan Bat, Riza Kutanis Int J Med Sci. 2012; 9(10): 909–915. Published online 2012 Nov 13. doi: 10.7150/ijms.4733
- Khan AN, Sawan A, Likourezos A, Schnellinger M, Garcia E. The usefulness of procalcitonin in the diagnosis of appendicitis in children: a pilot study. Emerg Med Int. 2012;2012:317504.
- Satendra Kumar, Jayant Maurya, Sandip Kumar, Shashi Kant Patne, and Amit Nandan Dhar Dwivedi A study of C-reactive protein and D-dimer in patients of appendicitis J Family Med Prim Care. 2020 Jul; 9(7): 3492–3495.
- Essam F Ebied, Ebied H. The diagnostic value of C-reactive protein and white blood cell count in diagnosis of acute appendicitis. Egypt J Surg 2016;35:1-4
- Vikrant Dharwal et al., Evaluation of procalcitonin as a predictor of severity of acute appendicitis. Int Surg J. 2020 Jun;7(6):1879-1885
- Chandel V, Batt SH, Bhat MY, Kawoosa NU, Yousuf A, Zargar BR. Procalcitonin as the biomarker of inflammation in diagnosis of appendicitis in pediatric patients and prevention of unnecessary appendectomies. Indian J Surg. 2011;73(2):136-41.
Corresponding Author
Dr Manikandan G
Junior Resident, Department of General Surgery, SSMC, Tumkur, India