title: Diagnostic markers in acute appendicitis.
abstract: BACKGROUND
  An adequate medical history combined with clinical examination is usually enough to make the diagnosis of acute appendicitis. The aim of this study was to determine the value of elevated white cell count (WCC), C-reactive protein (CRP), and bilirubin as diagnostic markers of acute appendicitis.
  
  
  METHODS
  A retrospective analysis was carried out on consecutive patients who underwent appendicectomy over a 3-year period. All data including patients' age, sex, blood test results, and appendix histology were summarized. Sensitivities, specificities, positive, and negative predictive values of WCC, CRP, and bilirubin were calculated separately or in combination for all patients.
  
  
  RESULTS
  A total of 447 patients were included. There is a significant difference in the results between patients with negative and positive appendicitis with regards to CRP (32 vs. 73; P < .001), mean total WCC (10.9 vs. 14.0; P < .001), and the mean levels of bilirubin (10.9 vs. 17.2; P < .001).
  
  
  CONCLUSIONS
  The diagnosis of appendicitis remains multifactorial and blood tests may help to guide the surgeon in the decision making.
authors.affiliation: Department of General Surgery, North Middlesex University Hospital NHS Trust, Sterling Way, London N18 1QX, UK. Electronic address: yalabed@yahoo.co.uk.
authors.forename: Yahya A
authors.initials: YA
authors.lastname: Al-Abed
authors.affiliation: Department of General Surgery, North Middlesex University Hospital NHS Trust, Sterling Way, London N18 1QX, UK.
authors.forename: Nasser
authors.initials: N
authors.lastname: Alobaid
authors.affiliation: Department of General Surgery, North Middlesex University Hospital NHS Trust, Sterling Way, London N18 1QX, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Myint
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000097:blood / Q000175:diagnosis*; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D001663:Bilirubin
keywords: Appendicitis; Bilirubin; Diagnosis; Diagnostic markers; Hyperbilirubinemia