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

Abstract

Background: Acute appendicitis is still known as one of the most common abdominal emergencies, one of the challenges encountered by the emergency physician is accurate diagnosis of acute appendicitis. In a trial to overcome these difficulties, this study aimed to assess the diagnostic accuracy of readily available and inexpensive inflammatory markers serum C-reactive protein (CRP) levels, white blood cells (WBCs), and neutrophils count in the diagnosis of acute appendicitis. Methods: This is a retrospective study. Two hundred and forty-one participants who performed appendectomy in King Abdulaziz University Hospital from January 1, 2013, to December 31, 2017, were included in this study, of which 148 (61.4%) were males and 93 (38.6%) were females. Chi-square and t-test were used for statistical analysis. Results: The study included 241 patients; the median CRP, WBCs, and neutrophils were significantly higher in patients who underwent open surgery and in complicated appendicitis compared to noncomplicated ones. Receiver operating characteristic curve analysis revealed higher accuracy of CRP in discrimination of acute appendicitis with a sensitivity and specificity of 94% and 57%, respectively. Conclusion: The diagnostic accuracy of the CRP is greater than the WBCs and neutrophil count. Thus, high serum CRP levels support the surgeon's clinical diagnosis. However, none of the studied markers is 100% diagnostic for acute appendicitis. It is recommended to include CRP measurement as a routine laboratory test in patients with suspected diagnosis of acute appendicitis.