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Normal inflammatory markers and acute appendicitis: a national multicentre prospective cohort analysis
J de Jonge1, J C G Scheijmans2, C C van Rossem3
1Department of Surgery, Tergooi Hospital Hilversum, Hilversum, The Netherlands.
International Journal of Colorectal Disease
|April 28, 2021
Summary
Acute appendicitis can rarely present with normal inflammatory markers, affecting 1.8% of patients. This highlights the need for comprehensive evaluation beyond white blood cell count and C-reactive protein levels in diagnosing appendicitis.
Area of Science:
- Medical Diagnostics
- Surgical Pathology
Background:
- Acute appendicitis diagnosis relies on clinical, laboratory, and imaging data.
- Inflammatory markers like white blood cell count (WBC) and C-reactive protein (CRP) are key indicators.
- However, appendicitis can manifest with normal inflammatory markers.
Purpose of the Study:
- To determine the incidence of normal inflammatory markers in patients undergoing surgery for acute appendicitis.
- To compare clinical and pathological findings between patients with normal versus elevated inflammatory markers.
Main Methods:
- Analysis of prospective data from the multicentre SNAPSHOT cohort study.
- Inclusion of adult patients with histopathologically confirmed acute appendicitis.
- Comparison of patients with normal preoperative WBC and CRP levels against those with elevated markers.
Main Results:
- 1.8% (23 of 1303) of patients with confirmed appendicitis had normal WBC and CRP.
- Normal inflammatory markers were associated with less frequent pain migration (17.4% vs 43.0%).
- Complicated appendicitis was rare in the normal marker group (0.3% overall).
Conclusions:
- Normal white blood cell count and C-reactive protein levels occur in approximately 2% of acute appendicitis cases.
- This presentation, though uncommon, can include complicated appendicitis.
- Diagnostic strategies should consider appendicitis even with normal inflammatory markers.
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