Objectives: To evaluate the diagnostic yield of preoperative estimation
of serum C-reactive protein (CRP) and total leucocytic count (TLC) as
adjuncts to modified Alvarado score (MAS) for diagnosis of acute
appendicitis (AA) and prediction of cases of complicated appendicitis
(CA).
Patients & Methods: The study included 324 patients underwent
appendicectomy; all patients underwent clinical examination and
calculation of MAS and had abdominal ultrasonography (US). Blood
samples were taken for estimation of serum CRP and TLC. Patients were
categorized according to intraoperative findings into: CA including those
had suppurative, gangrenous and/or perforated appendix, had
appendicular abscess or mass and Uncomplicated appendicitis (UA)
included patients had edematous or normal appendix.
Results: MAS defined 107 patients had score <7 and 217 patients had
score of >7 with a mean total score of 5.6±2.3; range: 2-9. MAS could
predict AA with 71.9% sensitivity, 68.2% specificity, 96%, positive
predictive value (PPV) and 15% negative predictive value (NPV) with
accuracy rate of 69.4%. Surgical exploration defined CA in 213 and UA
in 111 patients. US defined 185 CA cases and 139 UA patients with
53.1% sensitivity, 35.1% specificity, 61.1% PPV, 28% NPV and 46.9%
accuracy rate. TLC was >10,000 cells/ml in 193 patients, was <10,000
cells/ml in 131 patients. Serum CRP level of >10 mg/1 was defined in 230
patients, while 94 patients had serum CRP of <10 mg/l. Patients had CA
had significantly higher TLC and serum CRP compared to uncomplicated
cases. Preoperative leucocytosis defined CA with sensitivity rate of
71.4%, specificity rate of 61.3%, PPV of 77.9% and NPV of 52.7% with
accuracy rate of 67.9%. Preoperative serum CRP could define CA with
sensitivity rate of 83.1%, specificity rate of 42.3%, PPV of 73.4% and
NPV of 56.6% with accuracy rate of 69.1%. ROC curve analysis defined
high Alvarado score, TLC and serum CRP as the most sensitive predictors for CA. Regression analysis defined high serum CRP as a
significant predictor for CA, followed by MAS, high TLC, US and male
gender. |
