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Evaluation of Phospholipase A2 Activity, High Sensitive C- Reactive Protein Level and White Blood Cell Count as Predictive Markers in Acute Appendicitis: Novel Approach

Author(s): Suma S, Sreeramulu PN, Dayanand CD

We compared the predictive value of determining group II phospholipase A2 (PLA2) in serum for diagnosing acute appendicitis with the predictive values of white blood cell count (WBC) and measurement of C-reactive protein (CRP). In this prospective study, we included 62 patients who were undergoing appendectomy after clinical diagnoses of acute appendicitis. The performance of each test was measured by receiver-operating characteristic curves. The white blood cell count usually becomes elevated with infection. In early appendicitis, before infection sets in, it can be normal, but most often there is at least a mild elevation even early in the process. Unfortunately, appendicitis is not the only condition that causes elevated white blood cell counts.

Background

Appendicitis and acute abdominal pain are interrelated; pose to emergency surgical intervention for remedy. Despite of advanced techniques, the chance of appendicular perforation worsening the condition is high. An ideal approach to understand such an emergency scenario is more vital in patient care at health delivery system.

Materials and Methods

This Prospective study was conducted in 62 patients who have been clinically diagnosed as having acute appendicitis and posted for emergency appendectomy, from December 2016 to 2018. Pre-operatively blood was collected for high sensitive C- reactive protein (hs CRP) and PhospholipaseA2 (PLA2) estimation, after completion of surgical procedure, all specimens were sent for histopathological examination, which were correlated with the results of hs CRP levels and PLA2 activity.

Results

In present study, males (54.8%) outnumbered females (45.2%). In the study mean age of subjects was 26.77 ± 11.371 years. Majority of them were in the age group <20 years (38.7%), 25.8% were in the age group 21 to 30 years, 22.6% were in the age group 31 to 40 years and few >40 years (12.9%). In the study there was positive correlation between hsCRP and PLA2. i.e. with increase in hsCRP, there was increase in PLA2 and vice versa. However the correlation was not statistically significant.

Conclusion

PLA2 activity appears to be a promising new laboratory parameter for diagnosing acute appendicitis along with clinical examination. Patients with clinical signs and Symptoms of appendicitis and high hs CRP and PLA2 activity should be identified as having a higher probability of appendicular perforation.

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