C reactive protein compared with white blood cell count and erythrocyte sedimentation rate in the diagnosis of acute appendicitis in … (1986 Apr)
C reactive protein compared with white blood cell count and erythrocyte sedimentation rate in the diagnosis of acute appendicitis in children . acute abdominal symptoms in 162 children were investigated with rapidly quantified C reactive protein ( CRP ) , white blood cell ( WBC ) count and erythrocyte sedimentation rate ( ESR ) as laboratory parameters . When the symptoms had been present for at least 12 hours , the CRP level was greater than 10 mg / l in 72 of cases with histologic evidence of appendicitis , while leukocytosis ( WBC greater than 15 000 / mm3 ) and raised ESR ( greater than 20 mm / l h ) were found in 58 and 51 , respectively . If appendicitis had progressed to gangrenous stage , however , CRP alone was capable of identifying 83 of cases , while 76 had leukocytosis and 60 elevated ESR . When perforation had occurred there was greatly increased CRP and invariably leukocytosis , but elevated ESR in only 60 . With the combination CRP and WBC count ( using rise in one or both ) , 88 of all appendicitis cases could be identified , and at least 96 of those with gangrene or perforation . The predictive value of combined positive CRP and WBC tests was not less than 93 .

Quality control results of the first survey of pediatric surgery in hungary 161 patients underwent appendectomy at the surgical Unit … (1997 Oct)
quality control results of the first survey of pediatric surgery in hungary 161 patients underwent appendectomy at the surgical Unit of the department paediatrics , medical school of Pécs , hungary between 1 . january , 1988 and 31 . december , 1995 . biochemical results sedimentation rate , CRP ( C reactive protein ) and leucocytosis were compared to the operative findings as far as their predictive diagnostic value was concerned . The patients were grouped according to inflamed ( n 141 ) or non inflamed appendix ( n 20 ) . based on the outcome of statistical analysis the author concluded , that there was no significant difference between the informations given by the above mentioned biochemical results , regarding the strengthening of the preoperative diagnosis , also the combination of the data of the biochemistry tests did not help in deciding to operate on patients with suspected appendicitis . The changing policy and conditions of the health insurance in hungary are forcing the medical doctors to analyse more frequently the effectiveness of their activity .

Receiver operating characteristic analysis of leukocyte counts and serum C reactive protein levels in children with advanced appendicitis. (2006 May)
receiver operating characteristic analysis of leukocyte counts and serum C reactive protein levels in children with advanced appendicitis . purpose : To assess the diagnostic value of the white blood cell count ( WBC ) and serum C reactive protein ( CRP ) level in children with advanced appendicitis . methods : We reviewed 289 children ranging in age from 3 to 15 years old , who underwent appendectomy in our hospital between 1993 and 2003 . The advanced appendicitis group consisted of patients with associated perforation , abscess formation , or purulent ascites , and the simple appendicitis group consisted of patients who underwent uncomplicated appendectomy . We compared the age , sex , duration of abdominal pain before surgery , preoperative WBC and CRP level , and hospital stay in the two groups . We analyzed the diagnostic value of WBC and CRP level using a receiver operating characteristic ( ROC ) curve . results : The children in the advanced appendicitis group had a significantly longer duration of pain , a higher serum CRP level , and longer hospitalization than those in the simple group . The serum CRP levels had good diagnostic value in differentiating between the advanced and simple groups . Both the CRP level and the WBC in the patients who suffered abdominal pain for longer than 48 h before surgery had diagnostic value in differentiating between the advanced and simple groups . conclusion : these findings suggest that increased values of CRP and …

Predictive value of white blood cell count and C reactive protein in children with appendicitis. (2007 Jul)
predictive value of white blood cell count and C reactive protein in children with appendicitis . background / purpose : Few studies have addressed the predictive value of white blood cells ( WBCs ) and C reactive protein ( CRP ) at different cutoff values in appendicitis . Our purpose was to determine the cutoff values for WBC and CRP at different periods during clinical evolution of appendicitis and to establish their use for the diagnosis of appendicitis and differentiation of simple from perforated appendicitis . methods : We studied 198 patients operated on for appendicitis , which were further divided into 4 subgroups according to the time from the onset of symptoms to diagnosis . receiver operating characteristic curves were constructed for CRP and WBC ; the best cutoff points were used to calculate the sensitivity and specificity to discriminate patients with and without appendicitis and patients with simple and perforated appendicitis . results : white blood cell and CRP individually and together had a high sensitivity to differentiate patients with and without appendicitis . The specificity of WBC and CRP taken individually and together to differentiate patients with simple and perforated appendicitis was high , but the sensitivity was low . conclusions : white blood cell and CRP could be used to support the clinical diagnosis of appendicitis , and , depending on the time from the onset of symptoms to diagnosis , to differentiate patients with and without appendicitis and discriminate simple from perforated appendicitis .

Diagnostic value of C reactive protein in bacterial infections. (1998 Sep)
diagnostic value of C reactive protein in bacterial infections . review of the literature conflicting data for predictive values for C reactive protein ( CRP ) in its ability to distinguish between viral and bacterial diseases are reviewed . study designs regarding setting , patient mix , severity of disease and prevalence seem to determine the magnitude of predictive values . We have calculated predictive values for patients suspected of septicaemia , meningitis , appendicitis , cholecystitis , upper and lower respiratory disease , acute sinusitis and acute otitis media , and revealed the highest predictive values among patients suspected for severe and generalized infections . More localized diseases have lower predictive values . We emphasize the importance of a study design where the circumstances resemble the real situations in which the test is supposed to be used . This will ensure the clinical applicability of predictive values for a diagnostic test .

Role of leukocyte count , neutrophil percentage , and C reactive protein in the diagnosis of acute appendicitis in the … (2005 Jun)
Role of leukocyte count , neutrophil percentage , and C reactive protein in the diagnosis of acute appendicitis in the elderly . leukocyte count , neutrophil percentage , and C reactive protein ( CRP ) have been shown to give valuable information in the diagnosis of acute appendicitis . however , whether these laboratory tests have the same clinical applicability in the elderly as in young patients remains unclear . This retrospective study aimed to clarify the role of these tests in the diagnosis of acute appendicitis in patients aged 60 years or over . eighty five consecutive elderly patients underwent appendectomy for suspected acute appendicitis during a 30 month period . histologically verified appendicitis was found in 77 of the 85 patients ( 90 . 6 ) . there was no significant difference in leukocyte counts or CRP values between patients with acute appendicitis and those with a normal appendix . The sensitivities of leukocyte count , neutrophil percentage , and CRP in the diagnosis of acute appendicitis were 71 . 4 per cent , 88 . 3 per cent , and 90 per cent , respectively , while the specificities were 37 . 5 per cent , 25 per cent , and 37 . 5 per cent , respectively . Of 77 patients with acute appendicitis , only two had all three tests simultaneously normal . In conclusion , patients with normal results in all three tests are highly unlikely to have acute appendicitis and should be evaluated …

Diagnostic value of C reactive protein in children with perforated appendicitis. (1997 Jan)
diagnostic value of C reactive protein in children with perforated appendicitis . The diagnostic value of serum C reactive protein ( CRP ) levels in children with perforated appendicitis was prospectively studied in 78 consecutive patients with histologically confirmed appendicitis . The patients were divided into two groups : group A included 56 patients with perforated appendicitis and group B consisted of 22 patients with simple appendicitis . serum CRP level and leucocyte count were assayed in all and abdominal ultrasonography was performed in 75 . The mean age group A patient was significantly lower than that of group B patients ( 7 . 5 vs . 10 . 4 years , P 0 . 001 ) . group A patients had a significantly higher mean serum CRP levels than group B patients ( 92 vs . 31 mg / l , P 0 . 001 ) , while the mean leucocyte count was comparable in the two groups . Of 75 examined patients , 73 ( 97 ) had a pre operative sonographic diagnosis of appendicitis . conclusion : perforation is a common complication in children with appendicitis , especially in those of young age and with prolonged pain duration . greatly increased serum CRP levels ( or 50 mg / l ) and abdominal ultrasonography are important diagnostic aids in such patients .

Inflammation parameters in the diagnosis of acute appendicitis. (1988 Apr)
inflammation parameters in the diagnosis of acute appendicitis . The role of the common parameters of inflammation in the diagnosis of acute appendicitis was studied by measuring axillary temperature ( Tax ) , blood leukocyte ( Leuk ) and lymphocyte fraction ( lymph ) , serum C reactive protein ( CRP ) and ESR in 354 patients with clinical diagnosis of acute appendicitis . laparotomy showed normal appendix in 97 cases , but deduction of 14 with other surgically correctable disorders gave the negative appendectomy rate 83 / 354 ( 23 . 4 ) . The appendix had perforated in 9 . 9 . Tax , Leuk , lymph and CRP could significantly differentiate acute appendicitis from the other cases , with respective sensitivity ( and false positive ) percentages 88 . 7 ( 66 . 0 ) , 78 . 5 ( 24 . 7 ) , 84 . 4 ( 48 . 5 ) and 52 . 7 ( 24 . 7 ) . although such statistical differences are not particularly helpful in preoperative diagnosis of individual cases , none of the 37 patients with simultaneously normal Leuk , lymph and CRP had obvious appendicitis ( 2 probably had incipient inflammation ) . If laparotomy had not been performed in these 37 cases , almost half of the unnecessary operations could have been avoided , thereby reducing the negative appendectomy rate to 15 . 2 , with 11 . 7 perforation rate .

Laboratory aid in the diagnosis of acute appendicitis. (1989 Nov)
laboratory aid in the diagnosis of acute appendicitis . A blinded , prospective trial concerning diagnostic value of leukocyte count , neutrophil differential count , and C reactive protein . The diagnostic value of C reactive protein ( CRP ) , total white blood cell ( WBC ) count , total neutrophil count , and neutrophil differential count were evaluated in a prospective blinded study of 204 patients submitted with the tentative diagnosis of acute appendicitis . The laboratory tests were performed on blood samples obtained at the time of admission , and the results were stored until the patients were discharged . One hundred patients were operated on : 59 had appendicitis , 3 had other surgically correctable diseases , and 38 had a superfluous exploration . All 104 nonoperated patients recovered spontaneously . The sensitivity , specificity , and predictive values of single tests and test combinations were calculated at different cutoff levels . using standard reference intervals , WBC count demonstrated the best sensitivity ( 83 percent ) and predictive value of a negative result ( 88 percent ) . combining the tests by an or rule enhanced the sensitivity to 100 percent , employing WBC count or CRP or neutrophil percentage above the reference range ( triple test ) , but at the expense of the predictive value of a positive test ( 37 percent ) . It was concluded that both single tests and combined tests are of limited value in predicting acute appendicitis . …

Plasma D lactate levels in diagnosis of appendicitis. (2003 Aug)
plasma D lactate levels in diagnosis of appendicitis . We investigated the possible use of D lactate as a predictor in the diagnosis of appendicitis . C reactive protein level ( CRP ) and leukocyte counts were also evaluated . venous blood D lactate , CRP , and leukocyte counts were measured preoperatively in 53 patients undergoing surgery for appendicitis , as well as in 20 healthy subjects . levels of all three parameters in the surgical patients were significantly higher than in the control group ( p . 05 ) . previous studies have shown that venous D lactate is more specific to the intestine than CPR or leukocyte count . based on our data , venous D lactate , which had the lowest false negative rate among these laboratory parameters , may be a useful diagnostic marker for appendicitis . None of these parameters were helpful in identifying the type of the appendicitis .

Diagnostic value of reactive C protein in suspected acute appendicitis in children objective : The aim of this study was … (1998 Oct)
diagnostic value of reactive C protein in suspected acute appendicitis in children objective : The aim of this study was to evaluate the accuracy of C reactive protein ( CRP ) measurements in the diagnosis of suspected acute appendicitis ( AA ) during childhood . patients AND methods : A prospective study of 195 consecutive children , aged between 2 and 14 years and suspected of having AA , that attended a pediatric emergency room was carried out . We obtained a careful patient history , physical signs , blood test results , final diagnosis and the histological findings in the cases who underwent appendectomy ( classified as normal appendix , simple appendicitis ( SA ) or gangrenous appendicitis ( GA ) . results : The final diagnoses and their frequencies were : AA ( 94 ) , non specific abdominal pain ( 80 ) , mesenteric lymphadenitis ( 6 ) and others ( 15 ) . appendectomies were performed in 103 cases with 94 cases being AA ( 91 . 3 ) and of these 51 SA and 43 GA . The average values of CRP ( mg / l ) were : AA : 30 , SA : 16 , GA : 67 , non specific abdominal pain : 15 , and mesenteric lymphadenitis : 44 ( p 0 . 01 ) . The values of AG were statistically higher than those of SA ( p 0 . 0000 ) . The ROC curve of these data determined …

Tc 99m labeled leukocytes in imaging of patients with suspected acute abdominal inflammation. (1990 Nov)
Tc 99m labeled leukocytes in imaging of patients with suspected acute abdominal inflammation . One hundred patients with suspected acute abdominal inflammation were imaged at 0 . 5 , 2 3 , 4 6 , and 24 hours after the administration of Tc 99m hmpao labeled autologous leukocytes . Scan findings were retrospectively compared with final diagnosis , serum C reactive protein ( CRP ) , and antibiotic treatment . clinical findings were confirmed with surgery , barium enema , or sigmoidoscopy in 61 patients , and diagnosis was based only on clinical findings in 13 patients . In 26 patients , symptoms subsided before a final diagnosis was made . Tc 99m leukocyte images were positive in 45 of the 61 patients with a confirmed diagnosis , including all patients with acute cholecystitis ( N 4 ) and inflammatory bowel disease ( N 8 ) . They were also positive in nineteen out of 25 patients who had acute colonic diverticulitis and in 6 out of 7 who had intra abdominal abscesses . abnormal activity was found in patients with colonic carcinoma , small bowel infarction , and acute appendicitis . abnormal activity was visualized in 0 . 5 hour images in all but one of the positive cases . With the exception of two postoperative cases , malignant lymphoma , and a liver abscess , a CRP level of greater than 75 mg / L was associated with positive image findings . antibiotic treatment did not affect imaging …

The value of C reactive protein and leucocyte count in preventing negative appendectomies This study was designed to determine the … (2001 Nov)
The value of C reactive protein and leucocyte count in preventing negative appendectomies This study was designed to determine the values of C reactive protein measurements ( an acute phase reactant , CRP ) and leucocyte counts in prevention of negative appendectomies . despite improvements in diagnostic methods , negative appendectomy rates still remain between 10 30 in acute appendicitis . Cost effective and easily applicable diagnostic methods with prompt results are required to reduce negative appendectomy rates . In this prospective study , one hundred twenty six patients were operated on for initial diagnosis of acute appendicitis between July 1999 and July 2000 . CRP and leucocyte count were measured in all cases . The data of the outcomes of clinic and pathological findings were analyzed statistically . among the 126 study patients , 71 ( 56 . 3 ) were male and 55 ( 43 . 7 ) were female . 79 ( 62 . 6 ) cases had noncomplicated appendicitis , 27 ( 21 . 4 ) cases had complicated appendicitis and 20 ( 15 . 8 ) cases had negative appendectomy . The mean CRP level was significantly higher ( p 0 . 001 ) in patients with complicated acute appendicitis than in those with noncomplicated acute appendicitis and in those with negative appendectomy . The mean leucocyte count was significantly lower ( p 0 . 001 ) in patient with negative appendectomy than in those with noncomplicated appendicitis and in those with complicated appendicitis . …

Patients with clinical acute appendicitis should have pre operative full blood count and C reactive protein assays. (2006 Feb)
patients with clinical acute appendicitis should have pre operative full blood count and C reactive protein assays . introduction : The role of inflammatory markers in the diagnosis of acute appendicitis has not been clearly defined . The aims of this prospective audit were to define the role of the serum markers of inflammation total white cell count , neutrophil count and C reactive protein in the diagnosis of acute appendicitis with particular reference to the discrimination between uncomplicated and complicated appendicitis , and the prediction of abscess . patients AND methods : The author compiled a prospective database over a 13 month period of all appendicectomies performed . after five exclusions ( three having no notes for review and two having confounding second morbidity in the presence of a normal appendix ) , the data relating to 75 patients were analysed . results : In patients judged on clinical grounds to require laparotomy for suspected acute appendicitis , white cell count and neutrophil count distinguish acute appendicitis from normal appendices when used as categorical variables , though they do not reflect the presence of abscess . C reactive protein neither distinguishes appendicitis from normal , nor predicts abscess when used as a categorical variable , though higher levels suggest abscess . conclusions : laboratory tests of the white cell count , neutrophil count and C reactive protein are more effective in supporting a clinical diagnosis of acute appendicitis in patients with typical clinical features than in excluding the diagnosis …

Leucocyte count and C reactive protein in the diagnosis of acute appendicitis. (1999 May)
leucocyte count and C reactive protein in the diagnosis of acute appendicitis . background : The aim of the present work was to study the preoperative leucocyte counts and C reactive protein ( CRP ) values in three groups of patients operated on for a clinical suspicion of acute appendicitis with different findings at appendicectomy : an uninflamed appendix , uncomplicated acute appendicitis or complicated acute appendicitis . In particular , patients with acute appendicitis but a normal leucocyte count and CRP level were sought . methods : In this retrospective study , the mean preoperative leucocyte count and CRP value in 100 consecutive patients with an uninflamed appendix ( group A ) , in 100 consecutive patients with uncomplicated acute appendicitis ( group B ) and in 100 consecutive patients with complicated acute appendicitis ( group C ) were calculated . The numbers of patients with ( 1 ) both values normal , ( 2 ) only leucocyte count raised , ( 3 ) only CRP level raised and ( 4 ) both values raised were calculated in each of the three groups . results : The increase in leucocyte count was an early marker of appendiceal inflammation , whereas the CRP value increased markedly only after appendiceal perforation or abscess formation . group A ( uninflamed appendix ) contained 24 patients in whom both values were normal . neither group B ( uncomplicated acute appendicitis ) nor group C ( complicated acute appendicitis ) contained any patient with …

Clinical applications of C reactive protein in pediatrics. (1997 Oct)
clinical applications of C reactive protein in pediatrics . The body of literature concerning studies of the applications of CRP measurement in the pediatric population continues to grow . based on current data serial CRP measurements appear to be most useful for monitoring patient response to therapy after the primary diagnosis of invasive infectious or inflammatory diseases , for monitoring patients after major surgical procedures and those with serious burns . monitoring CRP over time may be used to assess for recrudescent disease , a secondary process or ineffective therapy . In addition CRP appears to be suited to most applications for which the ESR is used but offers many advantages . At present there are no objective outcome based clinical trial data to justify using CRP values alone , whether elevated or normal , as a basis for management decisions regarding instituting or withholding antimicrobial therapy , or its early discontinuance for patients suspected of having neonatal sepsis , meningitis , bacteremia or pneumonia , regardless of immune status . In addition , because of significant inconsistencies among studies for which CRP has been applied to differential diagnosis of bacterial vs . viral diseases , including meningitis , acute otitis media and lower respiratory tract infection , we cannot recommend it for this purpose . Data do not support a role for CRP in differential diagnosis of acute appendicitis or for localizing urinary tract infections .

Role of sequential leucocyte counts and C reactive protein measurements in acute appendicitis. (1992 Nov)
Role of sequential leucocyte counts and C reactive protein measurements in acute appendicitis . The accurate clinical diagnosis of acute appendicitis is difficult , and many techniques have been suggested to improve diagnostic accuracy such as laparoscopy , ultrasonography and barium enema examination . In this study serial total leucocyte counts and serial C reactive protein ( CRP ) concentrations in acute appendicitis were measured . The sensitivity and specificity of serial leucocyte counts in acute appendicitis were 92 and 100 per cent , and for CRP concentrations 69 and 75 per cent , respectively . The sensitivity and specificity of serial total leucocyte counts fulfilled the criteria for a diagnostic test . It is suggested that in patients with equivocal clinical findings , clinical observation combined with serial leucocyte counts may improve decision making .

The diagnostic value of repetitive preoperative analyses of C reactive protein and total leucocyte count in patients with suspected acute … (1995 Apr)
The diagnostic value of repetitive preoperative analyses of C reactive protein and total leucocyte count in patients with suspected acute appendicitis . background : studies have shown that C reactive protein ( CRP ) and total leucocyte count ( WBC ) in suspected acute appendicitis analysed only on admission gave valuable information to guide the surgeon . The aim of this study was to investigate the usefulness of CRP and WBC measured repetitively before operation . methods : during a 1 year period 227 patients were studied before emergency appendicectomy . CRP and WBC were analysed every 4th h . The upper limits of the reference intervals used were 9 . 0 x 10 ( 9 ) / l for WBC and 10 mg / l for CRP . results : Of the 227 appendicectomized patients , 170 ( 75 ) had acute appendicitis . sixty six of the patients were tested on two or more occasions every 4th h . forty six of these patients had appendicitis ; repetitive tests showed a continuing rise in CRP values but a continuing decrease in WBC . The negative appendicectomy rate among these 66 patients was 30 , which theoretically would have fallen to 19 if patients with normal results had not been subjected to surgery . conclusions : repeated laboratory tests for CRP and WBC should be performed in patients with suspected acute appendicitis requested to stay for further observation . If these test results are normal , the surgeon should …

Are serum inflammatory markers age dependent in acute appendicitis ? background : preoperative measurement of body inflammatory agents reduces unnecessary … (1997 Apr)
Are serum inflammatory markers age dependent in acute appendicitis ? background : preoperative measurement of body inflammatory agents reduces unnecessary appendectomies by up to 30 percent . A decline in the formation of blood leukocytes and C reactive protein with aging may hinder the correct diagnosis of appendicitis . study design : white cell count and C reactive protein were determined before appendectomy in 600 patients aged 0 to 5 years , 6 to 19 years , 20 to 39 years , 40 to 59 years , 60 to 79 years , and older than 80 years . their records were analyzed . The sensitivity , specificity , diagnostic accuracy , and receiver operating characteristic curves for C reactive protein and white cell count to predict appendicitis were calculated separately for each age group . results : The rates of negative explorations and perforations were highest at both extremes of age . In uncomplicated appendicitis , the diagnostic potential of white cell count was better than C reactive protein in all age groups except infants . The C reactive protein was elevated similarly throughout human life , but only in those with perforated appendicitis . The receiver operating characteristic curves confirmed that the performance of white cell count was better than C reactive protein in the correct diagnosis in every age group except infants and octogenarians . conclusions : The leukocyte response declines in 0 to 5 year old children with appendicitis , but the C reactive protein response is …

Would measurement of C reactive protein reduce the rate of negative exploration for acute appendicitis ? background : appendicectomy for … (2000 Jun)
would measurement of C reactive protein reduce the rate of negative exploration for acute appendicitis ? background : appendicectomy for suspected acute appendicitis is a common procedure . The rate of normal appendices unnecessarily removed remains high ( 15 30 ) despite several techniques and investigations used to improve the diagnostic accuracy . Many studies investigated the role of raised C reactive protein in improving the diagnosis of acute appendicitis , but with conflicting results . This study emphasies the impact of a normal ( rather than raised ) serum C reactive protein in reducing the rate of negative explorations . methods : In a double blind study , blood for the measurement of serum C reactive protein ( CRP ) was collected pre operatively from 78 patients just before going to the operating room for appendicectomy . The histopathology of the 78 appendices were grouped into positive ( acute appendicitis ) and negative ( normal appendix ) . white blood count ( WBC ) , CRP and the histopathology findings were correlated . results : In patients with histopathologically proven acute appendicitis both the WBC count and serum CRP level were significantly raised ( P 0 . 025 and P 0 . 000 , 1 respectively ) . serum CRP level was normal in 13 out of 15 negative explorations ( normal appendix on histopathology ) . The specificity and sensitivity of serum CRP was 86 . 6 and 93 . 6 , respectively . conclusion : A normal …