Role of C-reactive Protein, Leucocyte and Neutrophil Count in Diagnosis of Acute Appendicitis

Acute appendicitis is the most common cause of surgical acute abdomen and appendicectomy is the most commonly done surgery. Accurate preoperative diagnosis can reduce negative appendicectomy rate.Objective: To evaluate the diagnostic accuracy of C-reactive protein (CRP), total leucocyte count (TLC) and neutrophil count in patients operated after clinical diagnosis of acute appendicitis.Materials and Methods: This cross-sectional observational study was conducted among 100 patients at Combined Military Hospital, Dhaka from August 2012 to January 2013. Serum CRP level was measured by latex agglutination method which is a qualitative test and level of 6 mg / L was considered positive. TLC and neutrophil count were estimated by processing blood sample through automated haematology analyzer. TLC level of 10.5 x 109/L and differential count of neutrophil more than 75% were considered elevated.Results: Out of 100 cases the mean age of the patients was 21.7 years and 65 patients were male and 35 patients were female with male to female ratio 1.85:1. Majority cases (54%) were in the age group of 11-20 years. Clinical diagnosis was correct in 93% cases and negative appendicectomy rate was 07% (p<0.001). Appendix was found mostly inflamed (83%) and gangrenous (10%). CRP was highly sensitive (84.9%) and specific (85.7%) with diagnostic accuracy of 85%. TLC was also found equally sensitive and specific with diagnostic accuracy of 83%. Overall diagnostic accuracy of neutrophil was 76%.Conclusion: Diagnosis of acute appendicitis is essentially clinical supported by simple laboratory investigations like TLC and neutrophill count. Elevated levels of CRP, TLC and neutrophill count are helpful in confirming a suspected diagnosis of acute appendicitis. Appendicitis is very unlikely if the CRP, TLC and neutrophill counts are normal.JAFMC Bangladesh. Vol 17, No 1 (June) 2021: 26-29