Diagnostic Precision of C-Reactive Protein Levels, Neutrophil Count and Total Leukocyte Count in Identifying Acute Appendicitis Clinically

Author(s): Lal Bux Brohi, Mehwish Mooghal, Hussain Ahmed, Waseem Ahmad Khan, Jalil Malik, Tariq Mahmood Malik, Wajiha Khan, Kamran Rahim, Asrar Ahmad, Rana Hassan Javaid, Hina Tahseen


To identify diagnostic precision of C-reactive proteins levels, neutrophils and total leukocyte count in diagnosing acute appendicitis clinically, taking histopathology as a benchmark.


After permission from hospital’s ERC, the data collection was carried out at surgical department PNS Shifa over a period of Six months (13 October 2020 to 13 April 2021). Suspected patients of acute appendicitis reporting to OPD and emergency who were diagnosed clinically as having acute appendicitis were included in study. WBC count of >10,000 cells/mm3 and neutrophil count of >75% and CRP >6 mg/dl was considered positive. Histopathology reports of all clinical suspected patients were collected and compared with the laboratory tests done preoperatively to determine their diagnostic accuracy.


Mean age was 38.45(SD ± 6.32) with C. I (37.31...36.27) years. Out of 121 patients 50 (41.32%) were male and 71 (58.62%) were female. Diagnostic precision of CRP, TLC, neutrophils was (79.34%,76.03%,72.73%) in diagnosing acute appendicitis with sensitivity level of (80.88%,79.49%,74.36%), specificity (77.36%,69.77%,69.77%), PPV (82.09%,82.67,81.69) and NPV was found to be (75.93%,65.22%,60.0%) by using histology as benchmark.


It is to be concluded that combined C-reactive protein, TLC and neutrophils count yielded high diagnostic precision with high sensitivity and specificity as compare to CRP, TLC and NC separately. Combined CRP, TLC and NC is cheap, readily available and non-invasive imaging modality that is reasonably good and relatively comparable with the histopathology in diagnosing of acute appendicitis.

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