A COMPARATIVE STUDY TO EVALUATE THE POSITIVE PREDICTIVE VALUE OF BIOCHEMICAL MARKERS WITH CLINICAL RIPASA SCORE IN ACUTE APPENDICITIS: AN IN VIVO STUDY

Authors

  • Harpinder Singh Department of General Surgery, Pacific Medical College and Hospital, Udaipur, Rajasthan, India. https://orcid.org/0000-0002-5859-8266
  • Vishwas Johri Department of General Surgery, Pacific Medical College and Hospital, Udaipur, Rajasthan, India.
  • Tejpal Singh Saran Department of General Surgery, Pacific Medical College and Hospital, Udaipur, Rajasthan, India.

DOI:

https://doi.org/10.22159/ajpcr.2024.v17i2.48290

Keywords:

C-reactive protein, White blood cell, Raja Isteri Pengiran Anak Saleha Appendicitis, Acute appendicitis, Appendectomy

Abstract

Objective: We evaluated the positive predictive value of biochemical markers with clinical Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score and the sensitivity and diagnostic accuracy.

Methods: 75 patients who presented to the Emergency/General Surgery Department of Pacific Medical College and Hospital, Udaipur, with right iliac fossa (RIF) pain and who were suspected of acute appendicitis. A detailed history, clinical examination, and laboratory investigations were done which included a routine RIPASA score calculated.

Results: RIF pain was present in all the patients, followed by vomiting (98.67%), and fever in 92%. Twenty-one patients had raised white blood cell (WBC) counts, out of them 15 patients had both raised WBC counts and raised C-reactive protein (CRP) and 6 had normal CRP. 52 patients had raised CRP levels, out of them 15 patients had both raised WBC counts and raised CRP and 37 had normal WBC counts. 17 patients had both CRP and WBC counts in normal range, but were diagnosed to have appendicitis according to RIPASA score. Our results show that raised CRP and WBC counts had a sensitivity of 28.85% and specificity of 73.91% with a diagnostic accuracy of 42.67%.

Conclusion: When combined with WBC, CRP has good discriminatory power for appendicitis despite its inability to reliably predict acute appendicitis when used alone. However, a cutoff point for CRP that predicted perforated appendicitis could not be determined.

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Author Biographies

Harpinder Singh, Department of General Surgery, Pacific Medical College and Hospital, Udaipur, Rajasthan, India.

Resident,

Department of General Surgery,

PMCH, Udaipur

Vishwas Johri, Department of General Surgery, Pacific Medical College and Hospital, Udaipur, Rajasthan, India.

Professor,

Department of General Surgery,

PMCH, Udaipur

Tejpal Singh Saran, Department of General Surgery, Pacific Medical College and Hospital, Udaipur, Rajasthan, India.

Resident,

Department of General Surgery,

PMCH, Udaipur

References

McBurney C. IV. The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg 1894;20:38-43. doi: 10.1097/00000658-189407000-00004, PMID 17860070

Wagner JM, McKinney WP, Carpenter JL. Does this patient have appendicitis? JAMA 1996;276:1589-94, PMID 8918857

Sengupta A, Bax G, Paterson-Brown S. White cell count and C-reactive protein measurement in patients with possible appendicitis. Ann R Coll Surg Engl 2009;91:113-5. doi: 10.1308/003588409X359330, PMID 19102827

Owen TD, Williams H, Stiff G, Jenkinson LR, Rees BI. Evaluation of the Alvarado score in acute appendicitis. J R Soc Med 1992;85:87-8. doi: 10.1177/014107689208500211, PMID 1489366

Azaro EM, Amaral PC, Ettinger JE, Souza EL, Fortes MF, Alcântara RS, et al. Laparoscopic versus open appendicectomy: A comparative study. JSLS 1999;3:279-83. PMID 10694074

Williams GR. Presidential address: A history of appendicitis. With anecdotes illustrating its importance. Ann Surg 1983;197:495-506. doi: 10.1097/00000658-198305000-00001, PMID 6342553

Fitz RH. Perforating inflammation of the vermiform appendix. Am J Med Sci 1886;92:321-46.

Chong CF, Adi MI, Thien A, Suyoi A, Mackie AJ, Tin AS, et al. Development of the RIPASA score: A new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J 2010;51:220-5. PMID 20428744

McBurney C. Experiences with early operative interference in cases of diseases of the vermiform appendix. N Y Med J 1889;50:676-84.

Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 40th ed. London: Churchill Livingstone, Elsevier; 2008.

Akbar I, Shehzad JA, Ali S. Diagnostic accuracy of Ripasa score. J Ayub Med Coll Abbottabad 2019;31:411-4. PMID 31535517

Xharra S, Gashi-Luci L, Xharra K, Veselaj F, Bicaj B, Sada F, et al. Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis. World J Emerg Surg 2012;7:27. doi: 10.1186/1749-7922- 7-27, PMID 22866907

Panagiotopoulou IG, Parashar D, Lin R, Antonowicz S, Wells AD, Bajwa FM, et al. The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications. Ann R Coll Surg Engl 2013;95:215-21. doi: 10.1308/003588413X135116099 57371, PMID 23827295

Ak R, Doğanay F, Unal Akoğlu E, Akoğlu H, Uçar AB, Kurt E, et al. Predictive value of scoring systems for the diagnosis of acute appendicitis in emergency department patients: Is there an accurate one? HK J Emerg Med 2020;27:262-9. doi: 10.1177/1024907919840175

Shoshtari MH, Askarpour S, Alamshah M, Elahi A. Diagnostic value of Quantitative CRP measurement in patients with acute appendicitis. Pak J Med Sci 2006;22:300-3.

Yokoyama S, Takifuji K, Hotta T, Matsuda K, Nasu T, Nakamori M, et al. C-reactive protein is an independent surgical indication marker for appendicitis: A retrospective study. World J Emerg Surg 2009;4:36. doi: 10.1186/1749-7922-4-36, PMID 19878592

Published

07-02-2024

How to Cite

Singh, H., V. Johri, and T. S. Saran. “A COMPARATIVE STUDY TO EVALUATE THE POSITIVE PREDICTIVE VALUE OF BIOCHEMICAL MARKERS WITH CLINICAL RIPASA SCORE IN ACUTE APPENDICITIS: AN IN VIVO STUDY”. Asian Journal of Pharmaceutical and Clinical Research, vol. 17, no. 2, Feb. 2024, pp. 58-61, doi:10.22159/ajpcr.2024.v17i2.48290.

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