EVALUATING C-REACTIVE PROTEIN AND TOTAL LEUKOCYTE COUNT AS PREDICTIVE MARKERS FOR COMPLICATED APPENDICITIS

Abstract

Background and Aims:Appendicitis is a common surgical emergency, yet its still difficult to tell the difference between simple and complex cases. More severe forms of appendicitis, such gangrenous or perforated instances, have worse consequences and need prompt medical attention. In order to distinguish between simple and complex appendicitis, this study sought to assess the diagnostic accuracy of total leukocyte count (TLC) and C-reactive protein (CRP). Methods:This hospital-based observational research was undertaken at F.H. Medical College, Agra, from September 2022 to March 2024. After obtaining informed permission, 88 patients, ages 18 to 60, who were scheduled for appendicectomy were included. To quantify CRP (>60 mg/L) and TLC (>11,000/cumm), blood samples were obtained. For diagnosis, histopathological results constituted the gold standard. SPSS version 25.0 was used to analyze the data, and chi-square and ANOVA tests were used for statistical comparisons. To evaluate the diagnostic performance, Receiver Operating Characteristic (ROC) curves were created, with a significance threshold of p<0.05. Results:CRP demonstrated superior diagnostic accuracy with an AUC of 0.95 (p<0.001), sensitivity of 85.7%, and specificity of 90.9%. TLC showed an AUC of 0.66 (p=0.046), with 94.4% sensitivity but lower specificity at 37.1%. The projected cut-off for CRP was >94 mg/L and for TLC, >12,222/cumm. CRP also had a higher accuracy (90%) compared to TLC (48.9%). Conclusion:CRP emerged as a more reliable marker than TLC in predicting complicated appendicitis, with greater diagnostic accuracy and specificity. Larger multi-center studies are recommended to further validate these findings and establish universal cut-off values.