Diagnostic value of procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for acute complicated appendicitis

Abstract

Aim: Acute appendicitis (AA) is one of the most common surgical emergencies. Despite extraordinary advances in modern investigations, an accurate diagnosis of AA remains an enigmatic challenge. The purpose of this study was to examine the laboratory parameters studied during the preoperative period in patients who were histopathologically diagnosed with AA; C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin (PCT) in the differential diagnosis of complicated/uncomplicated appendicitis. Material and Method: This study included 106 patients, separated into two main groups; the uncomplicated appendicitis group (n = 74) and complicated appendicitis group (n = 32). The CRP, ESR, and PCT levels were calculated for all of the patients in the study. Results: No meaningful differences were observed among the groups, with regards to the sex of the patients. There was, however, a significant difference obtained between the (P> 0.05) CRP, ESR, and PCT values. Serum levels of ESR >31 (AUC = 0.706, P = 0.001, 95% GA: 0.610-0.791), in PCT>1.8 (AUC = 0.709, P = 0.001, 95% GA: 0.568-0.754), and CRP> 56.64 (AUC = 0.700, P <0.001, 95% GA: 0.603-0.785) were obtained. In both complicated appendicitis and uncomplicated appendicitis analyses, these values were found to be accurate. Using the cut-off values obtained in this study, the ESR, CRP, and PCT serum values, and odds ratios were calculated for complicated appendicitis by classification (odds ratio: 1.042 (0.990-1.097), 1.009 (0.998-1.020), and 2.986 (1.135-7.858), respectively. Discussion: We suggest that with a PCT level>1.8, CRP level>56.64, and ESR level >31, immediate and careful management must be undertaken, as the probability of complicated appendicitis is high.

The value of inflammatory markers in diagnosing acute appendicitis in pregnant patients

“…Synthesis of AFP proteins occurs in the liver as a result of cytokines released from tissue macrophages, and these proteins reflect nonspecifically the presence and severity of inflammation. [26,27] Proteins whose synthesis increase due to AFY are called positive reactants, while those whose synthesis decrease is termed acute phase reactants. In acute phase response secondary to inflammation in the organism, the amount of CRP increases, whereas the amount of albumin decreases.…”

“…[28] CRP is an acute phase reactant used quite frequently in the diagnosis of AA, and its sensitivity ranges from 40.0 to 95.6%, and its specificity varies from 53 to 82%. [27] In many studies examining the relationship between AA and CRP, the CRP level was reported to be especially high in complex appendicitis cases, such as perforation and periapical abscess. [27,29] Using a CRP cut-off level of 20 mg/L, Ayrık et al [14] reported a sensitivity level of 54.33% and a specificity level of 56.06% for CRP in AA cases.…”

“…[27] In many studies examining the relationship between AA and CRP, the CRP level was reported to be especially high in complex appendicitis cases, such as perforation and periapical abscess. [27,29] Using a CRP cut-off level of 20 mg/L, Ayrık et al [14] reported a sensitivity level of 54.33% and a specificity level of 56.06% for CRP in AA cases. On the other hand, Yokoyama et al [30] found a sensitivity level of 84.3% and specificity level of 75.8% using a cut-off value of 49.5 mg/L for CRP.…”

Acute Appendicitis: After Correct Diagnosis Conservative Treatment or Surgery?

“…Increased levels reflect the severity of acute appendicitis. Very high levels may reveal more complicated cases or sepsis [24]. WBC and neutrophil ratio, CRP, procalcitonine and SER are the most often used markers.…”