Abstract
ABSTRACTBackground: The C reactive protein (CRP) is one of the most accurate inflammatory markers in acute appendicitis (AA). Obesity leads to a pro-inflammatory state with increased CRP, which may interfere with the interpretation of this laboratory test in AA. Aim: To assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CRP in patients with AA and their correlation to body mass index (BMI) and body fat composition. Method: This is a retrospective study based on clinical records and imaging studies of 191 subjects with histopathologically confirmed AA compared to 249 controls who underwent abdominal computed tomography (CT). Clinical and epidemiological data, BMI, and CRP values were extracted from medical records. CT scans were assessed for AA findings and body composition measurements. Results: CRP values increased according to patients’ BMI, with varying sensitivity from 79.78% in subjects with normal or lean BMI, 87.87% in overweight, and 93.5% in individuals with obesity. A similar pattern was observed for NPV: an increase with increasing BMI, 69.3% in individuals with normal or lean BMI, 84.3% in overweight, and 91.3% in individuals with obesity. There was a positive correlation between CRP and visceral fat area in patients with AA. Conclusions: Variations exist for sensitivity, specificity, PPV, and NPV values of CRP in patients with AA, stratified by BMI. An increase in visceral fat area is associated with elevated CRP across the BMI spectrum.
Highlights
Acute appendicitis (AA) is the second most common surgical emergency in the United States[11]
Since C-reactive protein (CRP) can serve as an important diagnostic tool in informing the decision for AA surgery, and since its value can be subject to modification by body fat content, the present study aimed to evaluate CRP sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in AA diagnosis according to body mass index (BMI) in subjects with histopathologically confirmed AA diagnosed by computed tomography (CT)
CRP, clinical, laboratory and CT findings evaluation according to BMI
Summary
Acute appendicitis (AA) is the second most common surgical emergency in the United States[11]. Laboratory tests are useful to guide surgical treatment decisions[1]. C-reactive protein (CRP) test is widely used to investigate AA, with a high positive likelihood ratio for diagnosis, especially when correlated to white blood cell count[3]. It is considered to be the inflammatory marker with highest diagnostic accuracy for AA with great negative predictive values (NPV)[16]. CRP is a useful biomarker to assess drug treatment response[14] and to identify cases with potential for clinical complications[20]. AA-specific CT diagnostic criteria may include: ABCD Arq Bras Cir Dig 2018;31(1):e1339
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