C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study

One hundred and fifty patients who underwent appendectomies and had pathologically confirmed appendicitis were reviewed between May 1, 1999 and September 31, 2007. The correlation between preoperative clinical factors and the actual histological severity, and identify surgical indication markers were assessed by univariate and multivariate analyses.Univariate analysis showed that only the CRP level significantly differ between the surgical treatment necessary group (gangrenous appendicitis) and the possible non-surgical treatment group (catarrhalis and phlegmonous appendicitis). Multivariate analysis indicated only the CRP level to be a surgical indication marker for acute appendicitis. The receiver-operating characteristic (ROC) curve indicated that the cutoff value of CRP for surgical indication of appendicitis is 4.95 mg/dl.Only the CRP level is consistent with the severity of appendicitis, and considered to be a surgical indication marker for acute appendicitis.The treatment of appendicitis has been primarily managed by surgery. However, for those who present with catarrhalis (inflammation within the mucous membrane), or phlegmonous (inflammation in all layers) appendicitis, initial treatment by non-surgical management has been shown to be safe and effective[1,2]. A recent prospective multi-center randomized controlled trial showed that acute non-perforated appendicitis can be treated successfully with antibiotics[3]. The risk of recurrent appendicitis after non-surgical treatment is 5% to 37% [4-6]. Moreover, a routine interval appendectomy after successful non-surgical treatment is not justified and should be abandoned[7]. On the other hand, complicated appendicitis such as gangrenous (necrotic) appendicitis should be treated with emergency surgery[8]. Clinicians must determine the surgical indications after the diagnosis of appendicitis. This study investigated the possibility of a predictive common blood marker for distinguishing surgically indicated gangren