The role of total leucocyte count and C reactive protein in assisting with the diagnosis of acute appendicitis

Abstract

Introduction: Once patients present with pain in the right lower quadrant, one of the most common surgical conditions that they have to treat is acute appendicitis. Our aim is to study the value of preoperative C - reactive protein and total leucocyte count in diagnosing acute appendicitis and to correlate its value in grading of acute appendicitis as compared to Histopathological reports. Material and Methods: This is hospital based retrospective comparative study conducted in the Department of General Surgery at Yenepoya Medical College and Hospitals, Mangalore, a period of 5 years from, 2014-2019, to evaluate the accuracy of total leukocyte count and C - Reactive Protein (CRP) in the diagnosis of acute appendicitis. All patients above the age of 15 years diagnosed clinically to have acute appendicitis and subjected to appendicectomy were included. Patients with history of recurrent pain in right iliac fossa, patients with appendicular mass or peritonitis and concomitant conditions where C-reactive protein or Leukocyte Count is elevated were excluded. Results: There are about 80.6% cases of acute appendicitis, 2.3% appendicular mass, 8.4% complicated acute appendicitis, 8.0% malignancy and 0.8% others. CRP level had a sensitivity of 86.27% and specificity of 66.67% in predicting acute appendicitis. Total leucocyte count had a sensitivity of 87.65% and specificity of 100% in predicting acute appendicitis. Conclusion: Inflammation is known to cause an increase in CRP, but after complications have occurred, this increase is much more pronounced. The measurement of CRP or the counting of leucocytes on their own could be sufficient to prevent negative appendectomies.