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      Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis

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          Abstract

          Background

          Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of acute appendicitis is based on careful history, physical examination, laboratory and imaging investigation. The aim of the study is to analyze the role of C-reactive protein (CRP), white blood count (WBC) and Neutrophil percentage (NP) in improving the accuracy of diagnosis of acute appendicitis and to compare it with the intraoperative assessment and histopathology findings.

          Materials and methods

          This investigation was a prospective double blinded clinical study. The study was done on 173 patients surgically treated for acute appendicitis. The WBC, NP, and measurement of CRP were randomly collected pre-operatively from all involved patients. Macroscopic assessment was made from the operation. Appendectomy and a histopathology examination were performed on all patients. Gross description was compared with histopathology results and then correlated with CRP, WBC, and NP.

          Results

          The observational accuracy was 87,3%, as compared to histopathological accuracy which was 85.5% with a total of 173 patients that were operated on. The histopathology showed 25 (14.5%) patients had normal appendices, and 148 (85.5%) patients had acutely inflamed, gangrenous, or perforated appendicitis. 52% were male and 48% were female, with the age ranging from 5 to 59 with a median of 19.7. The gangrenous type was the most frequent (52.6%). The WBC was altered in 77.5% of the cases, NP in 72.3%, and C-reactive protein in 76.9% cases. In those with positive appendicitis, the CRP and WBC values were elevated in 126 patients (72.8%), whereas NP was higher than 75% in 117 patients (67.6%). Out of 106 patients with triple positive tests, 101 (95.2%) had appendicitis. The sensitivity, specificity, and positive predictive values of the 3 tests in combination were 95.3%, 72.2%, and 95.3%, respectively.

          Conclusion

          The raised value of the CRP was directly related to the severity of inflammation (p-value <0.05). CRP monitoring enhances the diagnostic accuracy of acute appendicitis. The diagnostic accuracy of CRP is not significantly greater than WBC and NP. A combination of these three tests significantly increases the accuracy. We found that elevated serum CRP levels support the surgeon's clinical diagnosis.

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          Most cited references31

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          C-reactive protein fifty years on.

          Mark Pepys (1981)
          The discovery of C-reactive protein (CRP) half a century ago led to the description of the acute-phase reaction which is a fundamental response of the body to injury. Recent work on the structure and function of CRP has revealed the existence of a unique plasma protein family, including CRP and serum amyloid P component (SAP). These proteins have been conserved throughout vertebrate evolution. CRP binds specifically to a wide range of substances derived both from damaged autologous cells and from microorganisms. Complexed CRP can activate the complement system and, by virtue of its dramatically increased production in response to tissue injury, it probably acts primarily as a protective mechanism. However, in some circumstances CRP may also initiate or exacerbate inflammatory lesions. Clinical measurement of serum CRP is valuable as a screening test for organic disease and as a sensitive object index of disease activity and response to therapy in some inflammatory, infective, and ischaemic conditions. SAP closely resembles CRP in structure but not an acute-phase reactant in man. An apparently identical protein, amyloid P component (AP), is always found in amyloid deposits. AP is also found in normal tissues, as an integral constituent of vascular basement membranes and is located on the peripheral microfibrillar mantle of elastic fibres throughout the body.
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            Hospital- and patient-level characteristics and the risk of appendiceal rupture and negative appendectomy in children.

            The rates of appendiceal rupture and negative appendectomy in children remain high despite efforts to reduce them. Both outcomes are used as measures of hospital quality. Little is known about the factors that influence these rates. To investigate the association between hospital- and patient-level characteristics and the rates of appendiceal rupture and negative appendectomy in children. Retrospective review using the Pediatric Health Information System database containing information on 24,411 appendectomies performed on children aged 5 to 17 years at 36 pediatric hospitals in the United States between 1997 and 2002. Rates of negative appendectomy and appendiceal rupture; the odds ratio (OR) of negative appendectomy and appendiceal rupture by hospital, patient age, race, and health insurance status, and hospital fiscal year and appendectomy volume. Negative appendectomy rate was defined as the number of patients with appendectomy but without appendicitis divided by the total number of appendectomies. The median negative appendectomy rate was 3.06% (range, 1%-12%) and the median appendiceal rupture rate was 35.08% (range, 22%-62%). The adjusted OR for appendiceal rupture was higher in Asian children (1.66; 95% confidence interval [CI], 1.24-2.23) and black children (1.13; 95% CI, 1.01-1.30) compared with white children. Children without health insurance and children with public insurance had increased odds of appendiceal rupture compared with children who had private health insurance (adjusted OR, 1.36; 95% CI, 1.22-1.53 for self-insured; adjusted OR, 1.48; 95% CI, 1.34-1.64 for public insurance). No correlation existed between negative appendectomy rate and race, health insurance status, or hospital appendiceal rupture rate. The negative appendectomy rate improved as the hospital appendectomy volume increased. The rate of appendiceal rupture in school-aged children was associated with race and health insurance status and not with negative appendectomy rate and therefore is more likely to be associated with prehospitalization factors such as access to care, quality of care, and patient or physician education.
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              Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis.

              The aim of the present work was to study the preoperative leucocyte counts and C-reactive protein (CRP) values in three groups of patients operated on for a clinical suspicion of acute appendicitis with different findings at appendicectomy: an uninflamed appendix, uncomplicated acute appendicitis or complicated acute appendicitis. In particular, patients with acute appendicitis but a normal leucocyte count and CRP level were sought. In this retrospective study, the mean preoperative leucocyte count and CRP value in 100 consecutive patients with an uninflamed appendix (group A), in 100 consecutive patients with uncomplicated acute appendicitis (group B) and in 100 consecutive patients with complicated acute appendicitis (group C) were calculated. The numbers of patients with (1) both values normal, (2) only leucocyte count raised, (3) only CRP level raised and (4) both values raised were calculated in each of the three groups. The increase in leucocyte count was an early marker of appendiceal inflammation, whereas the CRP value increased markedly only after appendiceal perforation or abscess formation. Group A (uninflamed appendix) contained 24 patients in whom both values were normal. Neither group B (uncomplicated acute appendicitis) nor group C (complicated acute appendicitis) contained any patient with both values in the normal range. Acute appendicitis is very unlikely when both the leucocyte count and CRP value are normal.
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                Author and article information

                Contributors
                Journal
                World J Emerg Surg
                World J Emerg Surg
                World Journal of Emergency Surgery : WJES
                BioMed Central
                1749-7922
                2012
                6 August 2012
                : 7
                : 27
                Affiliations
                [1 ]Department of Surgery, Regional Hospital, Prizren, Kosovo
                [2 ]Institute of Pathology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
                [3 ]Department of Microbiology, National Institute of Public Health of Kosovo, Prishtina, Kosovo
                [4 ]Department of Urology, University Clinical Center of Kosovo, Prishtina, Kosovo
                [5 ]Department of Abdominal Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
                [6 ]Department of Anesthesiology, University Clinical Center of Kosovo, Prishtina, Kosovo
                Article
                1749-7922-7-27
                10.1186/1749-7922-7-27
                3469372
                22866907
                67326109-ed97-42c7-b11f-0dee15bb3f92
                Copyright ©2012 Xharra et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 June 2012
                : 31 July 2012
                Categories
                Research Article

                Surgery
                histopathology findings,crp correlation,acute appendicitis,white blood count,neutrophil percentage

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