Laboratory Tests in Patients With Acute Appendicitis

Abstract

Abnormal laboratory findings cannot reliably deliver a diagnosis of acute appendicitis. However, acute appendicitis is very unlikely when leucocyte count, neutrophil percentage and CRP level are simultaneously normal.

Predictive Value of Leucocyte Count, Neutrophil Percent and C-Reactive Protein Concentration “Cut-Off Value” On The Diagnose Of Appendicitis

“…[6] Akut apandisit şüp-hesi ile ameliyata alınan hastalarda negatif laparotomi yapılan çalışmalarda %16.3-33.9 oranlarında saptanmıştır. [2,6,8,16] Bizim çalışmamızda negatif laparotomi oranı %20.6 olup, bu oran literatür bilgileri ile uyumludur.…”

“…Aynı çalışmada sensitivite %87.2, spesifite %33.1 tespit edilmiştir. [8] Yokoyama ve ark. nötrofil yüzdesi için ROC analizi ile komplike olmayan olgular için kesim değeri %83.1, komplike olgular için kesim değeri %84.4 olarak belirlemişlerdir.…”

“…Yüzde nötrofil'in sensitivesi %79-93 iken, spesifitesi düşüktür. [7] Diğer bir yardımcı tanısal test olan hepatositlerden sentezlenen CRP [8] akut faz proteinidir. Çeşitli çalışmalarda akut apandisitte yüksek CRP düzeylerinin tanıya yardımcı olduğu sonucuna varılmıştır.…”

Serum Biomarkers As a Diagnostic Aid in Acute Appendicitis

“…Thus a serial elevated WBC measurement (over 4-8 hours) in suspected cases may increase the specificity, as the WBC count often increases in acute appendicitis 10 (except in case of perforation, in which it may initially fall) [19]. Table 11: Sensitivity and specificity of white blood cell count in diagnosis of acute appendicitis References Sensitivity Specificity Yu et al [20] 62 75 Yang et al [21] 86 32 Xharra et al [22] 85 68 Wu et al [23] 80 71 Agrawal et al [24] 79 55 Mentes et al [25] 72 77 C reactive protein is the prototype acute phase reactant, synthesized by liver, its concentration rises within 8 hours of onset of tissue injury/inflammation, peaks 24 -48 hours and remains elevated as long as continuing tissue inflammation or destruction. CRP was identified in 1930 by Tillett and Francis as a substance in the serum of patients with acute inflammation that reacted with the C polysaccharide of pneumococcus.…”

Missed Appendicitis in Primary Care: Lessons Learned

“…The presence or absence of inflammatory markers is either support or refute diagnosis of acute appendicitis such as, increase level of leucocyte/neutrophil/granulocyte and C-reactive protein (CRP) [12][13][14][15]. Urine analysis and microscopy can either support or refute urinary tract infection, but it is confusing in pelvic acute appendicitis [16].…”