Multicenter Study

. 2021 Jul;36(7):1507-1513.

doi: 10.1007/s00384-021-03933-7. Epub 2021 Apr 27.

Normal inflammatory markers and acute appendicitis: a national multicentre prospective cohort analysis

J de Jonge¹, J C G Scheijmans², C C van Rossem³, A A W van Geloven¹, M A Boermeester⁴, W A Bemelman⁵; Snapshot Appendicitis Collaborative Study group

Collaborators, Affiliations

Collaborators

Snapshot Appendicitis Collaborative Study group:
G J Van Acker, B Akkermans, G J Akkersdijk, G D Algie, J H Allema, C S Andeweg, N Appeldoorn, J G van Baal, C M den Bakker, S A Bartels, C van den Berg, B Boekestijn, F C den Boer, D Boerma, A L van den Boom, M C Boute, S A Bouwense, J Bransen, F A van Brussel, O R Busch, S M de Castro, H A Cense, C Croese, T van Dalen, I Dawson, E van Dessel, R Dettmers, N Dhar, F Y Dohmen, K W van Dongen, P van Duijvendijk, R R Dulfer, B J Dwars, J P Eerenberg, M van der Elst, E van den Ende, L M Fassaert, J T Fikkers, J W Foppen, E J Furnee, F P Garssen, M F Gerhards, H van Goor, J S de Graaf, L J Graat, J Groot, A C van der Ham, J F Hamming, J T Hamminga, E van der Harst, J Heemskerk, A Heijne, J T Heikens, E Heineman, R Hertogs, E van Heurn, L C van den Hil, A G Hooftwijk, C C Hulsker, D R Hunen, M S Ibelings, J M Klaase, R Klicks, L Knaapen, R T Kortekaas, F Kruyt, S Kwant, S S Lases, T Lettinga, A Loupatty, R A Matthijsen, R C Minnee, B Mirck, L Mitalas, D Moes, A M Moorman, V B Nieuwenhuijs, G A P Nieuwenhuijzen, P D Nijk, J M Omloo, A G Ottenhof, H W Palamba, D L van der Peet, I T Pereboom, P W Plaisier, A P van der Ploeg, M H Raber, M M Reijen, H Rijna, C Rosman, R M Roumen, R F Scmitz, A P Schouten van der Velden, W H Scheurs, T A Sigterman, H J Smeets, D J Sonnevled, M N Sosef, S F Spoor, L P Stassen, L van Steensel, E Stortelder, J Straatman, H J van Susante, D E Suykerbuyk de Hoog, C Terwisscha van Scheltinga, B R Toorenvliet, P C Verbeek, M Verseveld, J H Volders, M R Vriens, P W Vriens, B C Vrouenraets, B J van de Wall, J A Wegdam, E Westerduin, J J Wever, N A Wijfels, B P Wijnhoven, T A Winkel, A M van der Zee D C Zeillemaker, C Zietse

Affiliations

¹ Department of Surgery, Tergooi Hospital Hilversum, Hilversum, The Netherlands.
² Department of Surgery, Amsterdam UMC, location AMC, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Amsterdam, the Netherlands. j.c.scheijmans@amsterdamumc.nl.
³ Department of surgery, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands.
⁴ Department of Surgery, Amsterdam UMC, location AMC, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Amsterdam, the Netherlands.
⁵ Department of surgery, Amsterdam University Medical Centers, location Amsterdam Medical Center, Amsterdam, the Netherlands.

PMID: 33907858
PMCID: PMC8195794
DOI: 10.1007/s00384-021-03933-7

Multicenter Study

Normal inflammatory markers and acute appendicitis: a national multicentre prospective cohort analysis

J de Jonge et al. Int J Colorectal Dis. 2021 Jul.

. 2021 Jul;36(7):1507-1513.

doi: 10.1007/s00384-021-03933-7. Epub 2021 Apr 27.

Authors

J de Jonge¹, J C G Scheijmans², C C van Rossem³, A A W van Geloven¹, M A Boermeester⁴, W A Bemelman⁵; Snapshot Appendicitis Collaborative Study group

Collaborators

Snapshot Appendicitis Collaborative Study group:
G J Van Acker, B Akkermans, G J Akkersdijk, G D Algie, J H Allema, C S Andeweg, N Appeldoorn, J G van Baal, C M den Bakker, S A Bartels, C van den Berg, B Boekestijn, F C den Boer, D Boerma, A L van den Boom, M C Boute, S A Bouwense, J Bransen, F A van Brussel, O R Busch, S M de Castro, H A Cense, C Croese, T van Dalen, I Dawson, E van Dessel, R Dettmers, N Dhar, F Y Dohmen, K W van Dongen, P van Duijvendijk, R R Dulfer, B J Dwars, J P Eerenberg, M van der Elst, E van den Ende, L M Fassaert, J T Fikkers, J W Foppen, E J Furnee, F P Garssen, M F Gerhards, H van Goor, J S de Graaf, L J Graat, J Groot, A C van der Ham, J F Hamming, J T Hamminga, E van der Harst, J Heemskerk, A Heijne, J T Heikens, E Heineman, R Hertogs, E van Heurn, L C van den Hil, A G Hooftwijk, C C Hulsker, D R Hunen, M S Ibelings, J M Klaase, R Klicks, L Knaapen, R T Kortekaas, F Kruyt, S Kwant, S S Lases, T Lettinga, A Loupatty, R A Matthijsen, R C Minnee, B Mirck, L Mitalas, D Moes, A M Moorman, V B Nieuwenhuijs, G A P Nieuwenhuijzen, P D Nijk, J M Omloo, A G Ottenhof, H W Palamba, D L van der Peet, I T Pereboom, P W Plaisier, A P van der Ploeg, M H Raber, M M Reijen, H Rijna, C Rosman, R M Roumen, R F Scmitz, A P Schouten van der Velden, W H Scheurs, T A Sigterman, H J Smeets, D J Sonnevled, M N Sosef, S F Spoor, L P Stassen, L van Steensel, E Stortelder, J Straatman, H J van Susante, D E Suykerbuyk de Hoog, C Terwisscha van Scheltinga, B R Toorenvliet, P C Verbeek, M Verseveld, J H Volders, M R Vriens, P W Vriens, B C Vrouenraets, B J van de Wall, J A Wegdam, E Westerduin, J J Wever, N A Wijfels, B P Wijnhoven, T A Winkel, A M van der Zee D C Zeillemaker, C Zietse

Affiliations

¹ Department of Surgery, Tergooi Hospital Hilversum, Hilversum, The Netherlands.
² Department of Surgery, Amsterdam UMC, location AMC, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Amsterdam, the Netherlands. j.c.scheijmans@amsterdamumc.nl.
³ Department of surgery, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands.
⁴ Department of Surgery, Amsterdam UMC, location AMC, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Amsterdam, the Netherlands.
⁵ Department of surgery, Amsterdam University Medical Centers, location Amsterdam Medical Center, Amsterdam, the Netherlands.

PMID: 33907858
PMCID: PMC8195794
DOI: 10.1007/s00384-021-03933-7

Abstract

Purpose: For the diagnosis of acute appendicitis, the combination of clinical and laboratory variables achieves high diagnostic accuracy. Nevertheless, appendicitis can present with normal laboratory tests of inflammation. The aim of this study was to investigate the incidence of normal inflammatory markers in patients operated for acute appendicitis.

Methods: This is an analysis of data from a prospective, multicentre SNAPSHOT cohort study of patients with suspected acute appendicitis. Only patients with histopathologically proven acute appendicitis were included. Adult patients with acute appendicitis and normal preoperative inflammatory markers were explored further in terms of abdominal complaints, preoperative imaging results and intraoperative assessment of the degree of inflammation and compared to those with elevated inflammatory markers.

Results: Between June and July 2014, 1303 adult patients with histopathologically proven acute appendicitis were included. In only 23 of 1303 patients (1.8%) with proven appendicitis, both preoperative white blood cell count and C-reactive protein levels were normal. Migration of pain was reported less frequently in patients with normal inflammatory markers compared to those with elevated inflammatory marker levels (17.4% versus 43.0%, p = 0.01). Characteristics like fever, duration of symptoms and localized peritonitis were comparable. Only 4 patients with normal inflammatory markers (0.3% overall) had complicated appendicitis at histopathological evaluation.

Conclusion: Combined normal WBC and CRP levels are seen in about 2 per 100 patients with confirmed acute appendicitis and can, although rarely, be found in patients with complicated appendicitis.

Keywords: Appendicitis; C-reactive protein; Complicated appendicitis; Inflammatory markers.

PubMed Disclaimer

Conflict of interest statement

None

Figures

**Fig. 1**
Flowchart: patients eligible for present cohort study

See this image and copyright information in PMC

References

1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557–564. doi: 10.1016/S0196-0644(86)80993-3. - DOI - PubMed
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1. Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91(1):28–37. doi: 10.1002/bjs.4464. - DOI - PubMed
1. Atema JJ, Gans SL, Beenen LF, Toorenvliet BR, Laurell H, Stoker J, Boermeester MA. Accuracy of white blood cell count and c-reactive protein levels related to duration of symptoms in patients Suspected of acute appendicitis. Acad Emerg Med. 2015;22(9):1015–1024. doi: 10.1111/acem.12746. - DOI - PubMed
1. Drake FT, Florence MG, Johnson MG, Jurkovich GJ, Kwon S, Schmidt Z, Thirlby RC, Flum DR, SCOAP Collaborative Progress in the diagnosis of appendicitis: a report from Washington state's surgical care and outcomes assessment program. Ann Surg. 2012;256(4):586–594. doi: 10.1097/SLA.0b013e31826a9602. - DOI - PMC - PubMed

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Normal inflammatory markers and acute appendicitis: a national multicentre prospective cohort analysis

Collaborators

Affiliations

Normal inflammatory markers and acute appendicitis: a national multicentre prospective cohort analysis

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials

Miscellaneous