Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis
Abstract Background The aim of this study is to test the diagnostic value of baseline and early change of C-reactive protein (CRP) concentrations, evaluated separately or in combination with the modified Alvarado score (MAS), in patients with clinically suspected acute appendicitis. Methods This is...
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | BMC Emergency Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12873-018-0166-5 |
| _version_ | 1828391413307408384 |
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| author | Mohamed Amine Msolli Kaouther Beltaief Wahid Bouida Nahla Jerbi Mohamed Habib Grissa Hamdi Boubaker Riadh Boukef Semir Nouira |
| author_facet | Mohamed Amine Msolli Kaouther Beltaief Wahid Bouida Nahla Jerbi Mohamed Habib Grissa Hamdi Boubaker Riadh Boukef Semir Nouira |
| author_sort | Mohamed Amine Msolli |
| collection | DOAJ |
| description | Abstract Background The aim of this study is to test the diagnostic value of baseline and early change of C-reactive protein (CRP) concentrations, evaluated separately or in combination with the modified Alvarado score (MAS), in patients with clinically suspected acute appendicitis. Methods This is a prospective observational study including all patients presenting to the emergency department with an equivocal diagnosis of acute appendicitis. After inclusion, clinical and demographic data are recorded and blood samples were taken at baseline and 3 h after for serum CRP measurements (3 h CRP). The MAS is also calculated for all patients. The ultimate diagnosis of appendicitis was based on the histologic findings of the excised appendix in operated patients and clinical follow-up in emergency department discharged patients. Diagnostic accuracy of admission CRP, early change of CRP 3 h CRP minus admission CRP, MAS and the combination of these parameters was expressed by sensitivity, specificity, positive predictive value, negative predictive value and area under receiver operating characteristics curve. Results Five hundred patients were included from January 2010 to December 2013. Overall, 387 patients were operated the negative appendectomy rate was 8,3%. CRP concentrations were higher in patients with acute appendicitis. However, the diagnostic value of admission CRP, delta CRP and MAS was moderate with area under ROC curve respectively equal to 0.63, 0.53 and 0.6. Combining admission CRP and delta CRP values to MAS did not result in a better performance. The area under ROC curve did not exceed 0.7 with the different combinations. Conclusion Early change of CRP has a moderate diagnostic value in patients with clinically suspected acute appendicitis. Combining CRP values to MAS did not improve diagnostic accuracy. |
| first_indexed | 2024-12-10T07:01:28Z |
| format | Article |
| id | doaj.art-8c390827767f4250b0c60c2537bdbbe1 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-10T07:01:28Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-8c390827767f4250b0c60c2537bdbbe12022-12-22T01:58:19ZengBMCBMC Emergency Medicine1471-227X2018-05-011811610.1186/s12873-018-0166-5Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitisMohamed Amine Msolli0Kaouther Beltaief1Wahid Bouida2Nahla Jerbi3Mohamed Habib Grissa4Hamdi Boubaker5Riadh Boukef6Semir Nouira7Emergency Department, FattoumaBourguiba University Hospital MonastirEmergency Department, FattoumaBourguiba University Hospital MonastirEmergency Department, FattoumaBourguiba University Hospital MonastirEmergency Department, Mahdia University HospitalEmergency Department, FattoumaBourguiba University Hospital MonastirEmergency Department, FattoumaBourguiba University Hospital MonastirEmergency Department, Sahloul University HospitalEmergency Department, FattoumaBourguiba University Hospital MonastirAbstract Background The aim of this study is to test the diagnostic value of baseline and early change of C-reactive protein (CRP) concentrations, evaluated separately or in combination with the modified Alvarado score (MAS), in patients with clinically suspected acute appendicitis. Methods This is a prospective observational study including all patients presenting to the emergency department with an equivocal diagnosis of acute appendicitis. After inclusion, clinical and demographic data are recorded and blood samples were taken at baseline and 3 h after for serum CRP measurements (3 h CRP). The MAS is also calculated for all patients. The ultimate diagnosis of appendicitis was based on the histologic findings of the excised appendix in operated patients and clinical follow-up in emergency department discharged patients. Diagnostic accuracy of admission CRP, early change of CRP 3 h CRP minus admission CRP, MAS and the combination of these parameters was expressed by sensitivity, specificity, positive predictive value, negative predictive value and area under receiver operating characteristics curve. Results Five hundred patients were included from January 2010 to December 2013. Overall, 387 patients were operated the negative appendectomy rate was 8,3%. CRP concentrations were higher in patients with acute appendicitis. However, the diagnostic value of admission CRP, delta CRP and MAS was moderate with area under ROC curve respectively equal to 0.63, 0.53 and 0.6. Combining admission CRP and delta CRP values to MAS did not result in a better performance. The area under ROC curve did not exceed 0.7 with the different combinations. Conclusion Early change of CRP has a moderate diagnostic value in patients with clinically suspected acute appendicitis. Combining CRP values to MAS did not improve diagnostic accuracy.http://link.springer.com/article/10.1186/s12873-018-0166-5C-reactive proteinAcute appendicitisAlvarado score |
| spellingShingle | Mohamed Amine Msolli Kaouther Beltaief Wahid Bouida Nahla Jerbi Mohamed Habib Grissa Hamdi Boubaker Riadh Boukef Semir Nouira Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis BMC Emergency Medicine C-reactive protein Acute appendicitis Alvarado score |
| title | Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis |
| title_full | Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis |
| title_fullStr | Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis |
| title_full_unstemmed | Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis |
| title_short | Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis |
| title_sort | value of early change of serum c reactive protein combined to modified alvarado score in the diagnosis of acute appendicitis |
| topic | C-reactive protein Acute appendicitis Alvarado score |
| url | http://link.springer.com/article/10.1186/s12873-018-0166-5 |
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