THE DIAGNOSTIC-VALUE OF REPETITIVE PREOPERATIVE ANALYSES OF C-REACTIVE PROTEIN AND TOTAL LEUKOCYTE COUNT IN PATIENTS WITH SUSPECTED ACUTE APPENDICITIS

Background: Studies have shown that C-reactive protein (CRP) and total leucocyte count (WBC) in suspected acute appendicitis analysed only o n admission gave Valuable information to guide the surgeon. The aim of this study was to investigate the usefulness of CRP and WBC measured repetitively before operation. Methods: During a 1-year period 227 pat ients were studied before emergency appendicectomy. CRP and WBC were a nalysed every 4th h. The upper limits of the reference intervals used were 9.0 x 10(9)/1 for WBC and 10 mg/l for CRP. Results: Of the 227 ap pendicectomized patients, 170 (75%) had acute appendicitis. Sixty-six of the patients were tested on two or more occasions every 4th h. Fort y-six of these patients had appendicitis; repetitive tests showed a co ntinuing rise in CRP values but a continuing decrease in WBC. The nega tive appendicectomy rate among these 66 patients was 30%,which theoret ically would have fallen to 19% if patients with normal results had no t been subjected to surgery. Conclusions: Repeated laboratory tests fo r CRP and WBC should be performed in patients with suspected acute app endicitis requested to stay for further observation. If these test res ults are normal, the surgeon should preferably refrain from operating but consider other differential diagnoses.