LEUKOCYTE ELASTASE AS A MARKER IN THE DIAGNOSIS OF ACUTE APPENDICITIS

Objective: To investigate the value of measuring the activity of the l eucocyte elastase complex in plasma in the diagnosis of acute appendic itis, either as a single or four-hourly test. Design: Open study. Sett ing: Teaching hospital, Sweden. Subjects: 165 consecutive patients adm itted with suspected acute appendicitis.Main outcome measures: Correla tion of concentrations of leucocyte elastase complex (elastase) and to tal white blood cell count (WBC) with C-reactive protein concentration and histological appearance of the appendix. Results: Of 165 patients , 101 patients had their appendixes removed, and of these 86 had histo logically confirmed appendicitis. An elastase value of less than 54 mu g/l was considered to be the reference range. Elastase activity measu red on admission gave a sensitivity of 61% and a specificity of 43% fo r acute appendicitis compared with the WBC which had a sensitivity of 81% and a specificity of 36%. The above blood tests were taken on two or more occasions four hourly after admission in 29 patients. Appendic itis was found in 25 of the 29 cases (87%), in which repeated tests sh owed a significant reduction in WBC together with a definite but not s ignificant reduction in the elastase activity during the preoperative period. Repeated tests were of no value. Conclusions: Measurement of t he leucocyte elastase complex in plasma does not increase the accuracy of the diagnosis of acute appendicitis. There was no significant corr elation between the leucocyte elastase activity and the total white ce ll count.