سرم و شمارش گلبول هاي سفيد در تشخيص بيماران مشكوك به آپانديسيت حاد CRP ارزش اندازه گيري

Accuracy of serum CRP measurement and WBC count in diagnosis of patients suspected to acute appendicitis

Background&Objective: Appendicectomy for suspected acute appendicitis is a common procedure. The rate of normal appendices unnecessarily removed remains high (15-30%) despite several techniques and investigations used to improve the diagnostic accuracy. Many studies investigated the role of raised C-reactive protein in improving the diagnosis of acute appendicitis. This study emphasizes the impact of a normal serum C-reactive protein in reducing the rate of negative explorations. Materials&Methods: In a double blind study, blood for the WBC count and measurement of serum C-reactive protein (CRP) was collected pre-operatively from 100 patients just before going to the operating room for appendicectomy. The histopathology of the 100 appendices was grouped into positive (acute appendicitis) and negative (normal appendix). White blood count (WBC), CRP and the histopathology finding were correlated. Results: In-patients with histopathologically proven acute appendicitis both the WBC count and serum CRP level were significantly raised (P=0.000and P=0.000respectively). Serum CRP level was normal in 16 out of 18 negative explorations (normal appendix on histopathology). The specificity and sensitivity of serum CRP was 88.8% and 92.6% respectively. Conclusion: normal pre-operative serum CRP measurement in-patients with suspected acute appendicitis is most likely associated with a normal appendix. Deferring surgery in this group of patients would probably reduce the rate of unnecessary appendicectomies.