The study of serum c-reactive protein and its diagnostic importance in reducing the rate of negative appendectomy

Bandana Kumari, Pawan Kumar, Neha Chaudhary, Anil Kumar, Achal Narain Roy


Background: Introduction-Acute appendicitis is the most common abdominal surgical emergency and appendectomy is one of the most frequently performed abdominal operation but the diagnosis of acute appendicitis remains an enigmatic challenge, plagued by high rate of negative exploration. The objective of this study was to assess the accuracy of CRP over TLC in the diagnosis of acute appendicitis.

Methods: Total 200 patients who had been diagnosed as a case of acute appendicitis based on WBC count and clinical diagnosis and were planned for appendectomy were selected for purposive sampling. Serum CRP was estimated in these patients before operation but was not considered in decision making process of appendectomy. All 200 removed appendixes were sent for histopathological examination.

Results: Result-Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of serum CRP were much greater than WBC count. Mean and standard deviation of serum CRP was 41.92±26.28 with p=<0.0001 which is highly significant.

Conclusions: Conclusion-CRP should be added along with clinical diagnosis and other laboratory test in diagnosis of acute appendicitis to reduce the rate of negative appendectomy.


Acute appendicitis, Appendectomy, C-reactive protein

Full Text:



Bhangu A, Soreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386:1278-87.

Alhalj MK, Abdrabo AA. The predictive value of c - reactive protein in diagnosis of acute appendicitis. J Sci. 2014;4(2):90-2.

Wattanasirichaigoon S. Leukocytic count in the diagnosis of acute appendicitis. J Med Assoc. 1994;(77):87-91.

Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006;333(7567):530-4.

Pu D, Bedalov G, Fridrih S, Vu I, Banek T, Pasini J. Urinalysis, ultrasound analysis, and renal dynamic scintigraphy in acute appendicitis. Urol. 1995;45(1):108-12.

Gregory, Charmaine. "Appendicitis". CDEM Self Study Modules. Clerkship Directors in Emergency Medicine. 2010;(2013):11-30.

Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med. 2014;15(7):859-71.

Reddan T, Corness J, Mengersen K, Harden F. Sonographic diagnosis of acute appendicitis in children: a 3‐year retrospective. Sonography. 2016;3(3):87-94.

Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001;286:1748-53.

Shilpa S. Shende, M.V. Bimanpalli, I.C. Apte, Vishakha V. Mahajan, Harshal P. Narkhede. Study of Lipid Profile and C Reactive Protein in Pre- and Post-menopausal Women.Journal of clinical and diagnostic research.2011;5(8):1544-47.

Unlu C, de Castro SM, Tuynman JB, Wust AF, Steller EP, Van Wagensveld BA. Evaluating routine diagnostic imaging in acute appendicitis. Int J Surg. 2009;7(5):451-5.

Tzanakis NE, Efstathiou SP, Danulidis K, Rallis GE, Tsioulos DI, Chatzivasiliou A, et al. A new approach to accurate diagnosis of acute appendicitis. W J Surg. 2005;29(9):1151-6.

Lee JH, Park YS, Choi JS. The epidemiology of appendicitis and appendectomy in South Korea: national registry data. J Epidemiol. 2010;20(2):97-105.

John SK, Joseph J, Shetty JR. Avoiding negative appendectomies in rural surgical practice: Is C-reactive protein estimation useful as a diagnostic tool? National Med J India. 2011;24(3).

Shindoh J, Niwa H, Kawai K, Ohata K, Ishihara Y, Takabayashi N, et al. Diagnostic power of inflammatory markers in predicting severity of appendicitis. Hepatogastroenterol. 2011;58(112):2003-6.

Shafi SM, Afsheen M, Reshi FA. Total Leucocyte Count, C-reactive Protein and Neutrophil Count: Diagnostic Aid in Acute Appendicitis. Saudi J Gastroenterol. 2009;15(2):117-20.

Iqbal J, Afzal Md, Sami F, Rehan AG. C-Reactive Protein; a diagnostic tool for acute appendicitis. APMC. 2007;(1)1.

Khan MN, Davie E, Irshad K. The role of White cell count and C-reactive protein in the diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2004;16(3):17-9.

Ali S, Shah O, Shah M, Ahmed L, Mallik S, Wani N. Role of total leukocyte count, neutrophil percentage, c-reactive protein and ultrasonography in the diagnosis of acute appendicitis. Int J Surg. 2009;24(1).

Jairaj R, Narendranath L, Ali F, Matew J, Tharanath K, Shyam T, et al. Serum biomarkers as a diagnostic aid in acute appendicitis. Int J Biomedi Adv Res. 2016;7(10):497-501.