[Leukocyte count, C reactive protein, alpha-1 acid glycoprotein and erythrocyte sedimentation rate in acute appendicitis].
BACKGROUND
The diagnosis of acute appendicitis is clinic, but in some cases, it can present unusual symptoms. The diagnostic difficulties still lead surgeons to unnecessary laparotomies, which reach rates from 15% to 40%. Laboratory exams, then, may become important to complement appendicitis diagnosis. The leucocyte count seems to be the most important value, but measurement of acute phase proteins, specially, the C-reactive protein, is object of several studies.


METHODS
This was a prospective study, involving 63 patients submitted to appendecectomies for acute appendicitis suspicion, in "Hospital das Clínicas", Federal University of Uberlândia, MG, Brazil, in whose blood were made dosages of acute phase proteins and the leucocyte count.


RESULTS
The sample was composed by 44 male and 19 female patients, and the majority of them was between 11 and 30 years of age. The flegmonous type was the most freq ent (52.4%). The leucocyte count was altered in 74.6% of the cases and C-reactive protein elevation was observed in 88.9%. The alfa-1 acid glycoprotein and the erithrocyte sedimmentation rate were predominantly normal. The C-reactive protein was augmented in more than 80% of the cases in all ages. Leucocyte count and C-reactive protein were altered in 80% of the patients with the limit of 24 hours from the beginning of symptoms. With clinical evolution time superior than 24 hours, the leucocyte count was altered in 69.7% of the cases, whereas C-reactive protein was in 97%. Sensibility and specificity of the leucocyte count were 88.7% and 20%. For the C-reactive protein, the values were, respectively, 88.9% and 10%. C-reactive protein dosage presented more sensible in cases with more than 24 hours of evolution (96.9%), although with no specificity. The alfa-1 acid glycoprotein and erithrocyte sedimmentation rate presented low sensitivity and specificity.


CONCLUSIONS
The leucocyte count and the C-reactive protein present significantly altered in acute appendicitis cases, independent from genre or age interval. The leucocyte count and, mainly, the C-reactive protein must be considered in individuals with more than 24 hours of clinical evolution. Augmented values, as a matter of fact, should never substitute the doctor's clinical examination, but complement it. The erithrocyte sedimmentation rate and the alfa-1 acid glycoprotein do not contribute to acute appendicitis diagnosis.
de Carvalho
Bruno Ramalho
BR
Faculdade de Medicina, Universidade Federal de Uberlândia, Belo Horizonte, MG, Brasil. brunoramalho@hotmail.com
Diogo-Filho
Augusto
A
Fernandes
Cleiton
C
Barra
Cristiane Borges
CB
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000097:blood* / Q000175:diagnosis; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008137:Longitudinal Studies; D008297:Male; D009961:Orosomucoid / Q000032:analysis*; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D009961:Orosomucoid; D002097:C-Reactive Protein