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Is C-reactive protein a reliable test for suspected appendicitis in extremely obese children?

Balazs Kutasy1, Ganapathy Laxamanadass, Prem Puri

  • 1The National Children's Hospital, Dublin, Dublin 24, Ireland.

Pediatric Surgery International
|October 27, 2009
PubMed

Insights

C-reactive protein (CRP) is not a reliable indicator for diagnosing appendicitis in extremely obese children. Obesity itself elevates CRP levels, potentially leading to misdiagnosis in pediatric cases.

Area of Science:

  • Pediatric Surgery
  • Pediatric Gastroenterology
  • Clinical Chemistry

Background:

  • Diagnosing acute appendicitis in extremely obese children presents challenges due to physical examination limitations.
  • C-reactive protein (CRP) is a common biomarker for appendicitis but is also elevated in obesity, a state of chronic inflammation.

Purpose of the Study:

  • To investigate the association between extreme obesity and C-reactive protein (CRP) levels in children with suspected appendicitis.
  • To evaluate the diagnostic utility of CRP in extremely obese pediatric patients compared to non-obese children.

Main Methods:

  • Retrospective analysis of 947 pediatric appendectomy records (2002-2008).
  • Categorization of patients into extremely obese (n=164) and non-obese groups based on standardized weight for age.
  • Comparison of CRP levels and diagnostic performance between the two groups.

Main Results:

  • Higher incidence of histologically normal appendix in extremely obese children (25.6%) versus non-obese (10.8%).
  • Mean CRP levels were significantly higher in extremely obese children with normal appendix compared to non-obese counterparts.
  • Lower specificity and positive predictive value of CRP in the extremely obese group.

Conclusions:

  • C-reactive protein (CRP) is an unreliable marker for appendicitis in extremely obese children.
  • Obesity status must be considered when interpreting elevated CRP levels in pediatric patients with suspected appendicitis.
Abstract

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