White cell count and C-reactive protein measurement in patients with possible appendicitis

Introduction Inflammatory markers such as white cell count (WCC) and C-reactive protein (CRP) and, more recently, bilirubin have been used as adjuncts in the diagnosis of appendicitis. The aim of this study was to determine the diagnostic accuracy of the above markers in acute and perforated appendicitis as well as their value in excluding the condition. Methods A retrospective analysis of 1,169 appendicectomies was performed. Patients were grouped according to histological examination of appendicectomy specimens (normal appendix = NA, acute appendicitis = AA, perforated appendicitis = PA) and preoperative laboratory test results were correlated. Receiver operating characteristic (ROC) curve area analysis (area under the curve [AUC]) was performed to examine diagnostic accuracy. Results ROC analysis of all laboratory variables showed that no independent variable was diagnostic for AA. Good diagnostic accuracy was seen for AA when all variables were combined (WCC/CRP/bilirubin combined AUC: 0.8173). In PA, the median CRP level was significantly higher than that of AA (158mg/l vs 30mg, p<0.0001). CRP also showed the highest sensitivity (100%) and negative predictive value (100%) for PA. CRP had the highest diagnostic accuracy in PA (AUC: 0.9322) and this was increased when it was combined with WCC (AUC: 0.9388). Bilirubin added no diagnostic value in PA. Normal levels of WCC, CRP and bilirubin could not rule out appendicitis. Conclusions CRP provides the highest diagnostic accuracy for PA. Bilirubin did not provide any discriminatory value for AA and its complications. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis.

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Serum C - Reactive Protein, White Cell Counts and Neutrophil Percentage are Predictors For Distal Ureteric Calculus Expulsion Rate: A Prospective Study

Journal of Nobel Medical College ◽

10.3126/jonmc.v8i1.24479 ◽

2019 ◽

Vol 8 (1) ◽

pp. 58-62

Author(s):

Ram Sagar Shah ◽

Kaushal Sigdel

Keyword(s):

Cell Count ◽

White Cell Count ◽

White Cell ◽

C Reactive Protein ◽

Expulsion Rate ◽

Reactive Protein ◽

Ureteric Calculus ◽

Cell Counts ◽

Neutrophil Percentage ◽

Wbc Count

Background: To determine the relationship between expulsion rate of distal ureteric calculus less than orequal to 10mm in size and C reactive protein (CRP) level, white cell count and neutrophil percentage. Materials and Methods: A total of 186 patients with distal ureteric calculus of ≤10mm were evaluated for stone expulsion rate and its correlation with serum CRP, white cell count and neutrophil percentage. All patients received tablet Tamsulosin 0.4mg for 4 weeks or till the expulsion of stone. Patients were called weekly till 4 weeks, or early if there was history of stone expulsion. Patients were divided in two groups according to normal and elevated CRP levels, white cell count and neutrophil percent age at baseline for statistical analysis. Results: The patients had an average age of 35.6 } 13.9 years. 52.2% were male. Ratio of right to left was1.58:1. Majority of the patients with distal ureteric calculus ≤ 10mm passed their stone (74.7 %) with medical expulsion therapy. Expulsion of stone less than 5mm was statistically significant (p0.017). Patients with normal neutrophil percentage and normal CRP level had higher stone expulsion rate than elevated neutrophil or CRP (85.2% vs. 40.9, 91.8% vs. 30.8% respectively).In patients with normal white cell count, 86.4% passed their stone while in elevated white cellcount group 39.1% passed their stone. Conclusion: This study showed patients with distal ureteric calculus of ≤10mmwith normal CRP level and normal neutrophil count had higher expulsion rate while WBC count showed no statistically significant association.

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What is the diagnostic value of white cell count, neutrophil count, C-reactive protein in acute and perforated appendicitis?

International Journal of Surgery ◽

10.1016/j.ijsu.2014.08.232 ◽

2014 ◽

Vol 12 ◽

pp. S96-S97

Author(s):

Kevin Cao ◽

Jessica Ng ◽

Zuhaib Keekeebhai

Keyword(s):

Cell Count ◽

Neutrophil Count ◽

White Cell Count ◽

Perforated Appendicitis ◽

Diagnostic Value ◽

White Cell ◽

C Reactive Protein ◽

Reactive Protein

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White Cell Count and C-Reactive Protein Measurement in Patients with Possible Appendicitis

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x359330 ◽

2009 ◽

Vol 91 (2) ◽

pp. 113-115 ◽

Cited By ~ 47

Author(s):

Anshuman Sengupta ◽

George Bax ◽

Simon Paterson-Brown

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Cell Count ◽

White Cell Count ◽

Lower Abdominal Pain ◽

White Cell ◽

C Reactive Protein ◽

Economic Implications ◽

Suspected Appendicitis ◽

Reactive Protein

INTRODUCTION Clinical assessment outweighs the use of investigations in the diagnosis of acute appendicitis. Nevertheless, white cell count (WCC) and C-reactive protein (CRP) are regularly measured in patients with suspected appendicitis. The aim of this study was to assess the utility of these markers in patients presenting with acute lower abdominal pain. PATIENTS AND METHODS WCC and CRP were measured prospectively in 98 patients presenting with lower abdominal pain, and the results were correlated with each patient's outcome. RESULTS No patients with WCC and CRP both in the normal range had acute appendicitis. Raised WCC and CRP were poor positive predictors of appendicitis, both alone and in combination, and correlated poorly with the development of complications. CONCLUSIONS This result may have important clinical and economic implications. We suggest that patients experiencing lower abdominal pain, with normal WCC and CRP values, are unlikely to have acute appendicitis and can be safely sent home.

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Patients with Clinical Acute Appendicitis Should have Pre-operative Full Blood Count and C-Reactive Protein Assays

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x83041 ◽

2006 ◽

Vol 88 (1) ◽

pp. 27-32 ◽

Cited By ~ 34

Author(s):

D Birchley

Keyword(s):

Acute Appendicitis ◽

Cell Count ◽

Neutrophil Count ◽

White Cell Count ◽

White Cell ◽

Full Blood Count ◽

Categorical Variables ◽

C Reactive Protein ◽

Reactive Protein

INTRODUCTION The role of inflammatory markers in the diagnosis of acute appendicitis has not been clearly defined. The aims of this prospective audit were to define the role of the serum markers of inflammation total white cell count, neutrophil count and C-reactive protein in the diagnosis of acute appendicitis with particular reference to the discrimination between uncomplicated and complicated appendicitis, and the prediction of abscess. PATIENTS AND METHODS The author compiled a prospective database over a 13-month period of all appendicectomies performed. After five exclusions (three having no notes for review and two having confounding second morbidity in the presence of a normal appendix), the data relating to 75 patients were analysed. RESULTS In patients judged on clinical grounds to require laparotomy for suspected acute appendicitis, white cell count and neutrophil count distinguish acute appendicitis from normal appendices when used as categorical variables, though they do not reflect the presence of abscess. C-reactive protein neither distinguishes appendicitis from normal, nor predicts abscess when used as a categorical variable, though higher levels suggest abscess. CONCLUSIONS Laboratory tests of the white cell count, neutrophil count and C-reactive protein are more effective in supporting a clinical diagnosis of acute appendicitis in patients with typical clinical features than in excluding the diagnosis.

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