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Open Access 01-12-2009 | Research article

C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study

Authors: Shozo Yokoyama, Katsunari Takifuji, Tsukasa Hotta, Kenji Matsuda, Toru Nasu, Mikihito Nakamori, Naoki Hirabayashi, Hiroyuki Kinoshita, Hiroki Yamaue

Published in: World Journal of Emergency Surgery | Issue 1/2009

Abstract

Background

This study is an attempt to clarify the role of C-reactive protein (CRP) as a surgical indication marker for appendicitis.

Methods

One hundred and fifty patients who underwent appendectomies and had pathologically confirmed appendicitis were reviewed between May 1, 1999 and September 31, 2007. The correlation between preoperative clinical factors and the actual histological severity, and identify surgical indication markers were assessed by univariate and multivariate analyses.

Results

Univariate analysis showed that only the CRP level significantly differ between the surgical treatment necessary group (gangrenous appendicitis) and the possible non-surgical treatment group (catarrhalis and phlegmonous appendicitis). Multivariate analysis indicated only the CRP level to be a surgical indication marker for acute appendicitis. The receiver-operating characteristic (ROC) curve indicated that the cutoff value of CRP for surgical indication of appendicitis is 4.95 mg/dl.

Conclusion

Only the CRP level is consistent with the severity of appendicitis, and considered to be a surgical indication marker for acute appendicitis.

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Eriksson S, Granstrom L: Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis. Br J Surg. 1995, 82: 166-169. 10.1002/bjs.1800820207.CrossRefPubMed

Oliak D, Yamini D, Udani VM, Lewis RJ, Arnell T, Vargas H, Stamos MJ: Initial nonoperative management for periappendiceal abscess. Dis Colon Rectum. 2001, 44: 936-941. 10.1007/BF02235479.CrossRefPubMed

Styrud J, Eriksson S, Nilsson I, Ahlberg G, Haapaniemi S, Neovius G, Rex L, Badume I, Granstrom L: Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial. World J Surg. 2006, 30: 1033-1037. 10.1007/s00268-005-0304-6.CrossRefPubMed

Brown CV, Abrishami M, Muller M, Velmahos GC: Appendiceal abscess: immediate operation or percutaneous drainage?. Am Surg. 2003, 69: 829-832.PubMed

Yamini D, Vargas H, Bongard F, Klein S, Stamos MJ: Perforated appendicitis: is it truly a surgical urgency?. Am Surg. 1998, 64: 970-975.PubMed

Friedell ML, Perez-Izquierdo M: Is there a role for interval appendectomy in the management of acute appendicitis?. Am Surg. 2000, 66: 1158-1162.PubMed

Kaminski A, Liu IL, Applebaum H, Lee SL, Haigh PI: Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis. Arch Surg. 2005, 140: 897-901. 10.1001/archsurg.140.9.897.CrossRefPubMed

Mason RJ: Surgery for appendicitis: is it necessary?. Surg Infect (Larchmt). 2008, 9: 481-488. 10.1089/sur.2007.079.CrossRef

Thimsen DA, Tong GK, Gruenberg JC: Prospective evaluation of C-reactive protein in patients suspected to have acute appendicitis. Am Surg. 1989, 55: 466-468.PubMed

10.

Dueholm S, Bagi P, Bud M: 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. Dis Colon Rectum. 1989, 32: 855-859. 10.1007/BF02554555.CrossRefPubMed

11.

Eriksson S, Granstrom L, Carlstrom A: The diagnostic value of repetitive preoperative analyses of C-reactive protein and total leucocyte count in patients with suspected acute appendicitis. Scand J Gastroenterol. 1994, 29: 1145-1149. 10.3109/00365529409094902.CrossRefPubMed

12.

Albu E, Miller BM, Choi Y, Lakhanpal S, Murthy RN, Gerst PH: Diagnostic value of C-reactive protein in acute appendicitis. Dis Colon Rectum. 1994, 37: 49-51. 10.1007/BF02047214.CrossRefPubMed

13.

Gurleyik E, Gurleyik G, Unalmiser S: Accuracy of serum C-reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression. Dis Colon Rectum. 1995, 38: 1270-1274. 10.1007/BF02049151.CrossRefPubMed

14.

Korner H, Soreide JA, Sondenaa K: Diagnostic accuracy of inflammatory markers in patients operated on for suspected acute appendicitis: a receiver operating characteristic curve analysis. Eur J Surg. 1999, 165: 679-685. 10.1080/11024159950189744.CrossRefPubMed

15.

Yildirim O, Solak C, Kocer B, Unal B, Karabeyoglu M, Bozkurt B, Aksaray S, Cengiz O: The role of serum inflammatory markers in acute appendicitis and their success in preventing negative laparotomy. J Invest Surg. 2006, 19: 345-352. 10.1080/08941930600985686.CrossRefPubMed

16.

Gronroos JM, Gronroos P: Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg. 1999, 86: 501-504. 10.1046/j.1365-2168.1999.01063.x.CrossRefPubMed

17.

Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ: Role of leukocyte count, neutrophil percentage, and C-reactive protein in the diagnosis of acute appendicitis in the elderly. Am Surg. 2005, 71: 344-347.PubMed

18.

Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ: Laboratory tests in patients with acute appendicitis. ANZ J Surg. 2006, 76: 71-74. 10.1111/j.1445-2197.2006.03645.x.CrossRefPubMed

19.

Bagi P, Dueholm S: Nonoperative management of the ultrasonically evaluated appendiceal mass. Surgery. 1987, 101: 602-605.PubMed

20.

Oliak D, Yamini D, Udani VM, Lewis RJ, Vargas H, Arnell T, Stamos MJ: Nonoperative management of perforated appendicitis without periappendiceal mass. Am J Surg. 2000, 179: 177-181. 10.1016/S0002-9610(00)00299-3.CrossRefPubMed

21.

Paajanen H, Mansikka A, Laato M, Kettunen J, Kostiainen S: Are serum inflammatory markers age dependent in acute appendicitis?. J Am Coll Surg. 1997, 184: 303-308.PubMed

22.

Eriksson S, Granstrom L, Bark S: Laboratory tests in patients with suspected acute appendicitis. Acta Chir Scand. 1989, 155: 117-120.PubMed

23.

Andersson RE, Hugander AP, Ghazi SH, Ravn H, Offenbartl SK, Nystrom PO, Olaison GP: Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis. World J Surg. 1999, 23: 133-140. 10.1007/PL00013174.CrossRefPubMed

Title: C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study
Authors: Shozo Yokoyama
Katsunari Takifuji
Tsukasa Hotta
Kenji Matsuda
Toru Nasu
Mikihito Nakamori
Naoki Hirabayashi
Hiroyuki Kinoshita
Hiroki Yamaue
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: World Journal of Emergency Surgery / Issue 1/2009
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/1749-7922-4-36

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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