PHOSPHOLIPASE A(2), C-REACTIVE PROTEIN, AND WHITE BLOOD-CELL COUNT INTHE DIAGNOSIS OF ACUTE APPENDICITIS

We compared the predictive value of determining group II phospholipase A(2) (PLA2) in serum for diagnosing acute appendicitis with the predi ctive values of white blood cell count (WBC) and measurement of C-reac tive protein (CRP). In this prospective study, we included 186 patient s who were undergoing appendectomy after clinical diagnoses of acute a ppendicitis. The performance of each test was measured by receiver-ope rating characteristic curves. WBC was the test of choice in diagnosing uncomplicated acute appendicitis. However, in contrast to CRP and PLA 2, which increased in patients with protracted inflammation, there was not a concomitant increase in WBC. Therefore, especially CRP, but als o PLA2, were better indicators of appendiceal perforation or abscess f ormation than was WBC. Increased WBC, CRP, and PLA2 values did not une quivocally corroborate the clinical suspicion of appendicitis, but if all three values were within normal limits, acute appendicitis could b e excluded with a 100% predictive value. PLA2 values showed a highly s ignificant correlation with CRP but not with WBC values, which support s the view that PLA2 represents an acute-phase reactant.