Jason Sam Paul, J (2020) Evaluation of CRP as an Additional Marker in the Diagnosis of Acute Appendicitis in a Tertiary Care Hospital. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
INTRODUCTION: Acute appendicitis is the most common abdominal surgical emergencies. A comprehensive history with detailed clinical examination, scoring systems, along with imaging modalities and laboratory investigations aids in the early diagnosis of acute appendicitis. Recently, CRP has been showed to be an emerging marker in predicting the severity of acute appendicitis. AIM OF THE STUDY: To predict the CRP levels in patients confirmed with histopathological diagnosis of acute appendicitis and appendicular perforation and to statistically correlate the CRP levels with Alvarado score, total counts, neutrophils, sonological appendicular diameter, duration of hospital stay and postoperative complications. METHODS: This is a prospective descriptive study done from November 2017 to August 2019 in the Department of General Surgery, Tirunelveli Medical College, Tirunelveli. The study population was 100 patients of age above 13 years, who were diagnosed, admitted and operated as a case of acute appendicitis with histopathological evidence of either acute appendicitis or appendicular perforation. Cases were selected by purposive sampling. Descriptive data were tabulated in frequency, mean, standard deviation. A comparison of continuous variables was done by one way ANOVA. Correlation of CRP levels with Alvarado score, Total counts, Neutrophils, appendicular diameter, duration of hospital stay and postoperative complications was done using Pearson correlation curve. RESULTS: The most common age group diagnosed with appendicitis is 19-30 years. The mean value of CRP in acute appendicitis was 13.06 mg/dl and in appendicular perforation was 36.95 mg/dl. There was a strong statistical correlation between CRP and Alvarado score in diagnosing Acute appendicitis and appendicular perforation. CRP values have been identified statistically using 95% Confidence value with the range of 9 mg/dl to 17.12 mg/dl in Acute Appendicitis and 30.90 mg/dl to 42.99 mg/dl in Appendicular Perforation. Pearson correlation for CRP with Alvarado Score, total counts, neutrophils showed a strong correlation with Alvarado score, medium correlation with the total count, small correlation with neutrophil count and no correlation with the appendicular diameter in USG. The surgical cutoff for appendicitis was greater than 9mg/dl. There was a very high statistically significant correlation between CRP and prolonged hospital stay by Pearsons correlation curve. Further Independent student “t” test compared CRP values with the development of complications in this study showed a statistical correlation of increased postoperative complications with increased preoperative CRP values. CONCLUSION: CRP levels can be considered for the diagnosis and choice of the treatment of appendicitis. Diagnostic precision of acute appendicitis has been increased significantly with the use of CRP. The current study suggests that CRP helps in the prediction of the severity of appendicitis for treatment, and a high frequency of development of postoperative complications with high preoperative CRP values. CRP can be a cost-effective investigation not only in predicting appendicular pathologies but also in anticipating postoperative complications.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711355 |
| Uncontrolled Keywords: | Acute appendicitis, Appendicular perforation, C Reactive Protein, Diagnosis, Predictor. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 11 Feb 2021 01:35 |
| Last Modified: | 11 Feb 2021 01:35 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14033 |
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