Inflammatuar markers in the diagnosis of acute appendicitis

Aim: To analyze the preoperative white blood cell count (WBC), C-reactive protein (CRP) concentration, fraction of neutrophil granulocytes (neutrophil count), and erythrocyte sedimentation rate (ESR), of the patients who were operated on for a clinical suspicion of acute appendicitis and who were separated into five groups with different findings at histopathologic examination. Method: 110 patients, who were operated on for suspected acute appendicitis in the last two years were evaluated prospectively. Blood was collected preoperatively from the patients for the measurement of serum CRP, WBC, ESR and neutrophil count. The histopathology of appendices were grouped into normal, grade 1, 2, 3 and 4 appendicitis. The relationship between inflammatory markers and histopathologic findings were examined. Results: In 10 (9%) of the 110 patients operated on, normal histopathologic findings were confirmed, in 13 (11.8 %) appendix was grade 1 (minor inflammation), in 29 (26.4%) appendix was grade 2 (inflammed), in 47 (42.8 %) appendix was grade 3 gangrenous and in 11 (10%) appendix was grade 4 (peforated). WBC was not amarker of increasing appendiceal inflammation. CRP increased markedly after appendiceal inflammation and increased gradually with histopathologic findings. Neutrophil count and ESR increased significantly after appendiceal inflammation but did not increase parallel to histopathologic findings. Conclusion: CRP level is an early marker of appendiceal inflammation and moreover repeated controls of the CRP concentrations may improve the accuracy of the diagnosing acute appendicitis.