title: Diagnostic power of inflammatory markers in predicting severity of appendicitis.
abstract: OBJECTIVE
  Severity of inflammation may be a risk factor for negative outcome in non-operative therapy of appendicitis. However, optimal screening test for predicting the pathological severity of appendicitis has not been established.
  
  
  METHODS
  632 consecutive patients who underwent appendectomy at a single institute were retrospectively reviewed. Clinical parameters are compared among the three pathological grades: simple (G1), gangrenous (G2), and perforated appendicitis (G3). The diagnostic power of inflammatory markers (WBC count and CRP concentration) in discriminating the advanced appendicitis from the milder one was evaluated.
  
  
  RESULTS
  CRP concentration was well correlated with the severity of appendicitis (p>0.0001), while WBC count showed only slight increase in advanced pathology (G1 vs. G2-G3). In receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was remarkably higher in CRP (AUC 0.809) compared with that in WBC count (AUC 0.617), suggesting that CRP is a more sensitive test in discriminating the pathological severity of appendicitis. Multivariate analysis confirmed that CRP concentration >6.2mg/dL (OR: 5.12; 95% CI: 2.17-12.7) and diameter >12mm (OR: 4.33; 95% CI: 1.98-9.90) were strong predictive factors for advanced appendicitis.
  
  
  CONCLUSIONS
  CRP concentration may be a potent objective predictor of pathological severity in appendicitis. Combination with the other diagnostic modalities may improve the diagnostic accuracy in predicting the severity of appendicitis.
authors.affiliation: Department of Surgery, Yaizu City General Hospital, Yaizu, Japan. shindou-tky@umin.ac.jp
authors.forename: Junichi
authors.initials: J
authors.lastname: Shindoh
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Niwa
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kawai
authors.forename: Ko
authors.initials: K
authors.lastname: Ohata
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ishihara
authors.forename: Naoki
authors.initials: N
authors.lastname: Takabayashi
authors.forename: Ryo
authors.initials: R
authors.lastname: Kobayashi
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Hiramatsu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein