The potential role of interleukin-6, endotoxin and C-reactive protein as standard biomarkers for acute appendicitis in adults

Abstract

Introduction/Objective. Acute appendicitis (AA) is by far the most frequent urgent condition in abdominal surgery and numerous biomarkers may help the physician to diagnose and even predict the severity of the disease. The objective of the paper was to determine the accuracy of C-reactive protein (CRP), interleukin-6 (IL-6) and endotoxin and compare it with the diagnostic value of Alvarado score (AS) in adults surgically treated for AA. Methods. Sixty-seven patients were diagnosed with AA using AS. Prior to surgery serum levels of inflammatory biomarkers were determined and together with AS were respectively compared to the results of histopathological analysis of specimens. The patients were divided into three group according to the histopathological assessment. Results. The univariate analysis revealed that the increase of CRP level by one unit increases the probability of complicated AA (CoAA) occurence by 1% (1.00 to 1.02, p < 0.05). ROC curve analysis has revealed that CRP has better capacity to predict supurative AA (SAAs)/CoAAs than catarrhal AA (CAA), with the cut-of value 19.45. Increase of AS value by one unit produced 2.98 fold increase of the probability of CoAA occurrence (1.60 to 5.57, p < 0.001), while positive AS value increases the probability of CoAA occurrence 24.67 times (4.94 to 123.12; p < 0.001). ROC curve analysis was demonstrated that AS may better predict CoAAs than CAAs/SAAs, with the cut-off value 8.50. Conclusion. AS and CRP should be routinely used combined as powerful tools for diagnosis and prediction of complicated AA.