A study of C-reactive protein and D-dimer in patients of appendicitis

Abstract

Background: Acute appendicitis is the most common abdominal surgical emergencies across the world. Objective: The aim of this study was to determine the value of C-reactive protein (CRP) and D-dimer as diagnostic markers of acute appendicitis. Study Design: It was a Prospective observational clinical study. Method: The present study was carried out in General Surgical Unit of University Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi from September 2015 to July 2017. All data including patient's demography, clinical examination, laboratory test results, and appendix histology were summarized. Receiver operating characteristic (ROC) curve of TLC, CRP, and D-dimer was analyzed. Results: Total 65 patients who presented with periumbilical pain or pain in right iliac fossa (RIF) were included in the study. The mean age of the patients was 31.18 ± 14.59 years (range: 15 to 65 years) with male : female ratio was 2.21:1. The most common symptom was pain in right iliac fossa (100%) followed by nausea/vomiting (69.2%). The mean leucocyte count, CRP, and D-dimer levels were significantly raised in appendicitis group as compared to negative appendicectomy group ( P = 0.025, P = 0.036, and P = 0.025, respectively). The receiver operating characteristic (ROC) curve for TLC was not helpful for differentiating between appendicitis and negative appendicitis ( P = 0.073). In addition, D-dimer was helpful for differentiating between appendicitis and negative appendicitis ( P = 0.002). However, CRP was also found to be helpful for differentiating between appendicitis and negative appendicitis ( P = 0.030). Conclusion: The diagnosis of appendicitis remains multifactorial and biochemical markers like CRP and D-dimer may help to guide the surgeon in the decision making.

Differences between inflamed and non inflamed appendices diagnosed as acute appendicitis

“…Elderly and immunosuppressed patients present clinical signs of acute appendicitis associated with ischemia and increased D-dimer levels [ 42 ]. These patients probably have no appendiceal inflammation and their ischemia is caused by a vascular obstruction.…”

Role of laboratory markers in identifying the severity of acute appendicitis in geriatric patients

“…While the incidence of AA in all age groups in the population is 7%, the incidence of perforation in patients with AA varies between 17-20%. The mortality rate in the general population is below 1%, but this rate approaches 50% in the geriatric age group (> 60 years) [1,2].…”