Predictive Value of TLC and CRP in the Diagnosis of Acute Appendicitis

Abstract

Objective:  To evaluate the diagnostic accuracy of increased TLC and CRP in making a reliable diagnosis of acute appen-dicitis by relying on preoperative levels of total leukocyte count and c- reactive proteins.

Subjects and Method:  A case control study done in Jinnah Hospital Lahore over one year. Total 150 patients who under went appendicectomy on the basis of clinical suspicion were included. Blood samples including Total Leukocyte count and C Reactive protein were sent preoperatively. Patients were divided in two main categories; Control, Group "A" (n 50) with un inflamed appendices and Cases, Group "B" (n 68) acute appendicitis and Group "C" (n 32) with complicated acute appendi-citis on the basis of operative findings and histopathology. The number of patients with either increased TLC or CRP or both TLC and CRP were sought.

Results:  Out of 150 patients there were 85 males and 65 females. In-group A maximum patients 58% turned up having ruptured / hemorrhagic ovarian cysts specificity of CRP was 86% and sensitivity 93% so a CRP levels within normal limits (6 ugm/dl) was associated with normal appendices in most of the of times. Very high levels, up to six times normal of CRP were found in complicated acute appendicitis. Positive predictive value of CRP and TLC both (100%) were as good as CRP (100%) alone as compared to TLC, (93%). Negative predictive value of TLC and CRP (66%) was better than TLC (50%) and CRP (50%). So both CRP and TLC are better than either TLC or CRP alone.

Conclusion:  CRP should be done as routine laboratory test along with TLC in doubtful cases of acute appendicitis.

Key words:  Appendicitis, TLC: total leukocyte count, CRP: C - reactive protein.