C-Reactive Protein and White Blood Cell Count as Biomarkers in the Diagnosis of Acute Appendicitis in Adults
Keywords:
Acute appendicitis, appendicectomy, negative appendicectomy, white blood cell count, c-reactive proteinAbstract
Background: The diagnosis of acute appendicitis is largely clinical and once established, management ensues. However, diagnostic difficulties may arise, leading to negative appendicectomies of 15% – 30% if surgery is effected. Attempts are being made to reduce this high negative appendicectomy rate.
Aim: To analyse the roles of White Blood Cell (WBC) count and C-Reactive Protein (CRP) in improving the accuracy of diagnosing acute appendicitis.
Methods: This was a cross-sectional, prospective study on Sixty-six (66) patients who presented to the accident and emergency ward of Irrua Specialist Teaching Hospital (ISTH) and diagnosed clinically as acute appendicitis. WBC count and CRP were done for all recruited patients preoperatively. All recruited patients had appendicectomy and the appendixes sent for histology.
Results: The mean age was 30 years ± 14 SD and male: female ratio was 1:1.8. The negative appendicectomy rate in this study was 19.7%. The diagnostic accuracy, sensitivity, specificity and positive predictive value for WBC count were 73%, 72%, 77% and 93% respectively. The diagnostic accuracy, sensitivity, specificity and positive predictive value for CRP were 80%, 79%, 85% and 95% respectively. Combining both markers gave accuracy, sensitivity, specificity and positive predictive value of 91%, 91%, 90% and 97% respectively. With ROC curve construction, CRP was a slightly better biomarker than WBC (AUC CRP: 0.79, p=0.0012; AUC WBC: 0.76, p=0.028).
Conclusion: Combined WBC and CRP improved predictive ability for acute appendicitis. Overall, CRP is a slightly better biomarker than WBC in predicting acute appendicitis.
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