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Ulus Travma Acil Cerrahi Derg. 2020 Jan;26(1):63-66. doi: 10.14744/tjtes.2019.14799.

High C-reactive protein level as a predictor for appendiceal perforation.

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Department of General Surgery, İstinye Universtity Faculty of Medicine, İstanbul-Turkey.
Department of General Surgery, Akdeniz University Faculty of Medicine, Antalya-Turkey.



Between 18% and 34% of acute appendicitis (AA) patients may have complicated appendicitis. Perforation is the most important complication of AA. Perforation increases morbidity and mortality. In this study, we aimed to investigate the role of basic inflammatory markers in the diagnosis of perforated AA.


A retrospective chart review was conducted of patients who underwent appendectomy with a diagnosis of AA between January 2014 and October 2019 at Akdeniz University Faculty of Medicine; and between December 2017 and October 2019 at Istinye University Faculty of Medicine Hospital. Markers recorded were as follows: white blood cell count, neutrophils, lymphocytes, platelets, c-reactive protein, mean platelet volume, red cell distribution width and eosinophils. Hematological indices were combined to generate the following three ratios: white cell neutrophil ratio, platelet lymphocyte ratio and neutrophil-lymphocyte ratio.


A total of 536 patients with a diagnosis of AA underwent an operation. There were 344 (64.1%) male patients and 192 (35.9%) female patients. The mean age of the patients was 36.7±16.2 (15-88) years. There were 94 (17.5%) patients with perforated AA and 442 (82.5%) patients with non-perforated AA. C-reactive protein (AUC: 0.81, p<0.001) was the most accurate markers in distinguishing the perforated and non-perforated group.


Elevated CRP level is a nonspecific inflammatory marker in most of the inflammatory diseases. A high CRP level can, therefore, be used as a supplement in the diagnosis of perforated AA.

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