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The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis
Jill Fennell1, Heather M Territo1, Nadya Telt1
1Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York.
Insights
Higher C-reactive protein (CRP) levels and Pediatric Appendicitis Score (PAS) correlate with increased appendicitis inflammation. These markers may help guide treatment decisions for appendicitis prior to surgery.
Area of Science:
- Pediatric Surgery
- Clinical Diagnostics
- Inflammatory Markers
Background:
- Acute appendicitis is a frequent cause of emergent abdominal surgery in children.
- C-reactive protein (CRP) and Pediatric Appendicitis Score (PAS) are potential predictors of appendicitis severity.
- These markers may aid in pre-operative treatment planning.
Purpose of the Study:
- To evaluate if CRP levels and PAS vary with the degree of appendix inflammation.
- To correlate laboratory and clinical findings with histological examination of the appendix.
Main Methods:
- Prospective observational study of 163 pediatric patients with appendicitis diagnosed via imaging.
- Collected CRP levels, calculated PAS, and reviewed appendix pathology.
- Histological appendix inflammation categorized as simple, suppurative, gangrenous, or perforated.
Main Results:
- CRP levels and PAS showed statistically significant differences across the four inflammation categories (p < 0.002).
- Higher CRP and PAS values were observed with increasing severity of appendicitis.
- Combined PAS ≥ 8 and CRP > 40 mg/L yielded 91.2% specificity for complicated appendicitis.
Conclusions:
- Elevated CRP and PAS are associated with more severe histological inflammation in appendicitis.
- CRP and PAS show potential as tools to assist in clinical decision-making for appendicitis management.
Background:
Acute appendicitis is a common cause of abdominal pain leading to emergent abdominal surgery in children. C-reactive protein (CRP), an inflammatory marker typically elevated in acute appendicitis, and Pediatric Appendicitis Score (PAS), a clinical scoring system used for the diagnosis of appendicitis, have the potential to predict the severity of inflammation of the appendix. This may be useful in helping the physician make a treatment plan prior to surgery.
Objective:
The purpose of this study was to assess whether CRP value and PAS differ with the extent of inflammation of the appendix seen on histologic examination.
Methods:
This was a prospective observational study of patients diagnosed with acute appendicitis via computed tomography or ultrasound. Enrolled patients had CRP levels drawn, PAS calculated, and appendix pathology reviewed. Appendix pathology was categorized by the pathologist on the basis of the level of inflammation: simple, suppurative, gangrenous, and perforated.
Results:
One hundred sixty-three patients were enrolled. CRP levels and PAS were statistically different (p < 0.002) among the four pathology classifications. Patients with simple appendicitis (n = 3) had a mean CRP of 2.95 mg/L and PAS of 3.9, patients with suppurative appendicitis (n = 99) had a mean CRP of 26.89 mg/L and PAS of 6.5, patients with gangrenous appendicitis (n = 56) had a mean CRP of 91.11 mg/L and PAS of 7.5, and patients with perforated appendicitis (n = 6) had a mean CRP of 154.17 mg/L and PAS of 7. The results remained statistically significant (p < 0.002) after adjusting for age, race, and sex. When combined-PAS ≥ 8 and CRP level > 40 mg/L-the specificity of complicated appendicitis was 91.2% and positive predictive value was 72.7%.
Conclusions:
Higher CRP levels and PAS were associated with increased histologic inflammation of the appendix. This study provides preliminary evidence that CRP and PAS could potentially assist in treatment decisions for appendicitis.
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