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Laboratory tests in patients with acute appendicitis.

Horng-Ren Yang1, Yu-Chun Wang, Ping-Kuei Chung

  • 1Department of Surgery, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung 404, Taiwan.

ANZ Journal of Surgery
|February 18, 2006
PubMed
Summary

This study evaluated the usefulness of three laboratory tests—leucocyte count, neutrophil percentage, and C-reactive protein (CRP)—in diagnosing acute appendicitis. Researchers reviewed medical records of 897 patients who underwent appendicectomy and compared their lab results with histopathological findings. They found that while these tests correlate with the severity of inflammation, they are not reliable on their own for confirming appendicitis. However, when all three tests are normal, the likelihood of appendicitis is very low. The study suggests that normal results across all three tests may help rule out the condition, but abnormal results should be interpreted with caution. The findings highlight the importance of combining laboratory data with clinical signs and histopathological confirmation for accurate diagnosis.

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Area of Science:

  • Surgical diagnostics in emergency medicine
  • Inflammatory biomarker analysis
  • Clinical laboratory testing

Background:

Current diagnostic protocols for suspected acute appendicitis rely on clinical signs and laboratory tests. While leucocyte count, neutrophil percentage, and C-reactive protein (CRP) are frequently used, their diagnostic accuracy remains unclear. Prior research has shown these biomarkers correlate with inflammation, but their sensitivity and specificity for appendicitis diagnosis are not well established. No prior work had resolved whether normal values across all three tests reliably exclude the condition. This gap motivated a retrospective analysis of patient records to assess the reliability of these tests in diagnosing appendicitis. The study aimed to determine if these tests can be used independently or in combination to improve diagnostic accuracy. No existing studies have provided a comprehensive evaluation of all three biomarkers together in this context. This uncertainty drove the need for a detailed retrospective review of medical records and histopathological findings. The goal was to clarify the role of these tests in confirming or ruling out acute appendicitis.

Keywords:
Acute appendicitis diagnosisCRP test sensitivityLeucocyte count accuracyEmergency medicine diagnostics

Frequently Asked Questions

The study found that normal leucocyte count, neutrophil percentage, and CRP level together strongly suggest the absence of acute appendicitis.

The researchers compared median CRP levels in patients with ruptured appendicitis (96.8 mg/L) versus those with normal appendices (39.6 mg/L).

The study found that CRP levels were not significantly different in patients with uncomplicated appendicitis versus those with normal appendices.

Histopathological confirmation was used to validate the presence or absence of appendicitis in all patients.

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Purpose Of The Study:

The aim of this study was to evaluate the diagnostic value of leucocyte count, neutrophil percentage, and CRP in patients with suspected acute appendicitis. The researchers sought to determine the sensitivity and specificity of each test and their combinations. They wanted to assess whether abnormal results could reliably confirm appendicitis. The motivation stemmed from the need to improve diagnostic accuracy in emergency settings. The study focused on patients who underwent appendicectomy and had histopathological confirmation of appendicitis. The researchers intended to correlate laboratory findings with the severity of inflammation. They also aimed to determine if normal results across all three tests could rule out the condition. This approach was designed to provide evidence-based guidance for using laboratory tests in diagnosing acute appendicitis.

Main Methods:

The study used a retrospective design, analyzing medical records of 897 patients who underwent appendicectomy. Histopathological confirmation of appendicitis was obtained for each case. Laboratory data including leucocyte count, neutrophil percentage, and CRP levels were collected. The researchers compared these values with the severity of appendiceal inflammation. Statistical analysis was performed to calculate sensitivity and specificity for each test. They also evaluated combinations of abnormal test results. The median CRP levels were compared between patients with ruptured and normal appendices. The study focused on identifying patterns in test results that correlated with confirmed appendicitis.

Main Results:

Histologically confirmed appendicitis was found in 740 of 897 patients (82.5%). Leucocyte count and neutrophil percentage increased with the severity of inflammation. Median CRP levels were significantly higher in patients with ruptured appendicitis (96.8 mg/L) compared to those with normal appendices (39.6 mg/L). However, CRP levels were not significantly different in patients with uncomplicated appendicitis (24.1 mg/L) versus those with normal appendices (39.6 mg/L). The sensitivity of leucocyte count, neutrophil percentage, and CRP was 85.8%, 87.2%, and 76.5%, respectively. Specificity was 31.9%, 33.1%, and 26.1%, respectively. Only six patients with appendicitis had all three tests within the reference range. These findings suggest that normal results across all three tests strongly indicate the absence of appendicitis.

Conclusions:

The study found that abnormal leucocyte count, neutrophil percentage, and CRP levels are not reliable for confirming acute appendicitis. However, normal results across all three tests strongly suggest the absence of the condition. The researchers propose that these tests should be interpreted with caution when used alone. The findings suggest that a normal leucocyte count, neutrophil percentage, and CRP level together may help rule out appendicitis. The study supports the use of these tests in combination rather than individually. The authors emphasize the importance of correlating laboratory findings with clinical signs and histopathological results. They propose that normal values across all three tests could guide clinical decisions in emergency settings. The study highlights the need for further research to refine diagnostic criteria for acute appendicitis.

The sensitivity of leucocyte count in diagnosing acute appendicitis was 85.8%.

The authors suggest that normal results across leucocyte count, neutrophil percentage, and CRP strongly indicate the absence of appendicitis.