Association rate of leukocytosis increased CRP and ESR with acute appendicitis

Acute appendicitis is one of the most common problems requiring emergency surgery. Diagnosis is based on history، physical examination and laboratory findings. Rate of misdiagnosis of appendicitis especially in female is up to 23. 2 %. Some basic laboratory examinations such us white blood cell count، CRP and ESR have been suggested as aids in the diagnosis of acute appendicitis. But results are controversial. This study was designed to evaluate the association between leukocytosis، increased CRP and ESR and acute appendicitis. In this retrospective study، 200 patients were admitted with clinical diagnosis of acute appendicitis from October 2009 to March 2010 in Booali hospital in Tehran. Blood samples for WBC، CPR and ESR were sent to the laboratory preoperatively. Then sensitivity، specificity، positive and negative predictive value (PPV and NPV) of these tests were determined and analyzed. There were 124 males (62%) and 76 females (38%) The mean age was 29 years range 15 to 80 years. 186 (93%) patients have histologically confirmed appendicitis and 14 (7%) had normal appendix. Sensitivity، specificity، PPV and NPV for leukocytosis were in order: 84. 5%، 34%، 92% and 16. 7%; for increased CRP were in order 75. 3%، 28%، 91. 4% and 11%، and for increased ESR were: 72%، 22%، 90. 5%، 5%، respectively. When all tests are used for diagnosis، these criteria were 56%، 68. 5%، 96. 3% and 10. 9% respectively. In attention to sensitivity and value of positive (PPV) and increased WBC، CRP and ESR، it can be resulted that positive value of these tests in suspected appendicitis can strengthen the clinical diagnosis but lowered value of negative (NPV) testes showed that the negativity of each test or all tests together cannot verify acute appendicitis. In presence of leukocytosis، increased CPR & ESR probability of appendicitis was increased in clinically acute appendicitis. But normal value of WBC، CRP&ESR don''t rule out acute appendicitis.