The efficacy of C-reactive protein, white blood cell count and neutrophil percentage in the diagnosis of acute appendicitis in Kirkuk city

Abstract

Background: One of the commonest emergencies in surgical practice (pediatric and general surgery) is acute appendicitis which is associated with acute phase reaction. Diagnosis of acute appendicitis is still a challenging issue for surgeons because lifetime risk of acute appendicitis is high (in some series reach 8%), rate of negative exploration is also high (in some series reach 35%) and complications of acute appendicitis (mainly perforation of appendix) are still high, especially in developing countries (in some series reach 62%). Several modalities have been used for diagnosis of acute appendicitis which include scoring systems (e.g. Alvarado scoring system), imaging techniques (ultrasound and computerized tomography), and laboratory investigations (white blood cell count, neutrophil percentage, C-reactive  protein  and  some  other  serological  markers)  in  order  to  improve  diagnosis, reduce negative exploration rate and reduce complications rate. The aim of study is to evaluate efficacy of (CRP, WBC count and neutrophil percentage) in diagnosis of acute appendicitis. Patients and methods: The study was conducted at the beginning of January to the end of August 2018. Thirty  male patients, whose age between 10-40 years and admitted to emergency department of Kirkuk general hospital and diagnosed clinically as acute appendicitis by same surgeon, were studied. In emergency department, white blood cell count (WBC) and neutrophil percentage (NP) are estimated by same automated analyzer in same laboratory (as part of complete blood count estimation). C- reactive protein (CRP) was  estimated  qualitatively  by  latex  agglutination  technique  in  same  laboratory.  Appendicectomy was done by same surgeon and decision was done regarding whether appendix was inflamed or not macroscopically (by same surgeon) and microscopically (by histopathological examination by same histopathologist). Chai-squared test was used to compare between means of variables. Results: There were significant relations between onset of symptoms and results of CRP results, onset of symptoms and end diagnosis, and WBC  count  and  end  diagnosis.  All  other  relations  were  non-significant.  Conclusions: Diagnosis of acute appendicitis remains a challenging issue in clinical practice. Frequent clinical examination remains the best method for accurate diagnosis of acute appendicitis. Laboratory investigations can be used as an adjuvant in diagnosis of acute appendicitis..