Thirumallai Siva, Wijesuriya Suraj Ruwan, Mitchell Andrew, Delriviere Luc
General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
ANZ J Surg. 2014 May;84(5):335-6. doi: 10.1111/ans.12408. Epub 2013 Oct 10.
The aim of the study was to evaluate whether C-reactive protein (CRP) level on admission could aid the diagnostic accuracy of Alvarado score in acute appendicitis.
We retrospectively evaluated hospital records and database of 234 patients (men 116, women 118, median age 28 years, range 15-87 years) who underwent appendicectomy for acute appendicitis. Patients were categorized into three groups retrospectively based on the Alvarado score. Group I: score 7-10 (n = 155), group II: score 4-6 (n = 71), group III: score less than 3 (n = 10). Negative (NPV) and positive predictive values (PPV) of CRP was calculated.
Overall, 169 of 234 (72.2%) had histopathological confirmation of acute appendicitis. The predicted accuracy of Alvarado score was 84.5% in group I, 50.7% in group II and 25% in group III. The PPV of high CRP and NPV of normal CRP for group I was 88% and 36.4%, in group II, 63% and 72%, in group III, 33% and 86%, respectively.
The Alvarado score and CRP taken together improve the predictive value of diagnosing acute appendicitis. Having a normal CRP in the equivocal group of Alvarado 4-6, should be further evaluated by advanced imaging before proceeding to appendicectomy.
本研究旨在评估入院时C反应蛋白（CRP）水平是否有助于提高急性阑尾炎Alvarado评分的诊断准确性。
我们回顾性评估了234例行急性阑尾炎阑尾切除术患者（男性116例，女性118例，中位年龄28岁，范围15 - 87岁）的医院记录和数据库。根据Alvarado评分将患者回顾性分为三组。第一组：评分7 - 10（n = 155），第二组：评分4 - 6（n = 71），第三组：评分小于3（n = 10）。计算CRP的阴性预测值（NPV）和阳性预测值（PPV）。
总体而言，234例患者中有169例（72.2%）经组织病理学证实为急性阑尾炎。Alvarado评分在第一组的预测准确率为84.5%，第二组为50.7%，第三组为25%。第一组中高CRP的PPV和正常CRP的NPV分别为88%和36.4%，第二组分别为63%和72%，第三组分别为33%和86%。
Alvarado评分和CRP联合使用可提高急性阑尾炎诊断的预测价值。对于Alvarado评分为4 - 6的可疑组中CRP正常的患者，在进行阑尾切除术之前应通过先进影像学进一步评估。
