Use of changes over time in serum inflammatory parameters in patients with equivocal appendicitis

The aim of this prospective study was to determine whether the change between the initial and subsequent analysis of serum inflammatory markers measured 6 to 10 hours later could improve diagnostic accuracy in appendicitis.

The study group comprised 225 patients who presented to hospital with equivocal signs of appendicitis from 2003 to 2004. Based on the period from the onset of symptoms to admission, receiver operating characteristic (ROC) curves were used to determine cutoff values of the changes between primary and repeated laboratory examinations in diagnosing appendicitis.

ROC analysis showed that the cutoff values for the change in total percentage neutrophil count on the first day after onset of symptoms (3.2%), and a change of in CRP concentration above the baseline on the second day (9.5 mg/L) and the third day (17.0 mg/L) after onset of symptoms were significant parameters for diagnosing acute appendicitis.

The cutoff values of the change in total neutrophil count on the first day after onset of symptoms and the change in CRP on the second and third days after onset of symptoms during in-hospital observation may serve as useful parameters to surgeons in differentiating acute appendicitis from other acute abdominal diseases.