Pre-operative and post-operative changes in values of CRP and hemogram in children with perforated appendicitis

INTRODUCTION: Since acute appendicitis is a clinical condition that develops after inflammation of the appendix, changes in the markers related to infection are expected in the laboratory tests of these cases. In this study, it was aimed to determine the changes in C-reactive protein (CRP) and hemogram examinations taken before and after surgery in children with perforated appendicitis and even to determine the markers that could indicate appendix perforation.
METHODS: This study was conducted in children with perforated appendicitis who were operated on in our pediatric surgery department in 2019. Only patients whose pre-operative and post-operative laboratory tests were performed in our hospital were included in the study. The demographic characteristics, pre-operative and post-operative (CRP, White blood cell [WBC], neutrophil, lymphocyte, mean platelet volume [MPV], and platelets [PLT]) values were analyzed retrospectively.
RESULTS: Only 69 of 141 children with perforated appendicitis who were operated on in 2019 had pre- and post-operative tests performed in our hospital. Of the 69 cases included in our study, 29 were female (40.1%) and 40 were male (59.9%). The median pre-operative values of CRP, WBC, neutrophil, lymphocyte, MPV, and PLT were 4.4 (0.2–21.66) mg/dL, 14.46 (5.27–32.6) 103/mm3, 10.03 (2.6–20.25) 103/mm3, 1.76 (0.17–8.69) 103/mm3, 8.7 (6.99–134) fL, and 280 (134–497) 103/mm3, respectively. The median values of CRP, WBC, Nötrofil, Lenfosit, MPV, and PLT on the 5th post-operative day were 3.8 (0.2–17.7) mg/dL, 11.39 (4.4–36.8) 103/mm3, 8.63 (2.12–22.02) 103/mm3, 1.75 (0.41–6.17) 103/mm3, 8.7(6.5–146) fL, and 286 (146–721) 103/mm3, respectively. The difference of CRP and WBC between pre- and post-operative values was found to be significant based on Wilcoxon Signed Rank Test (Non-parametric) (<0.05).
DISCUSSION AND CONCLUSION: Moderately high CRP and WBC values are important as an infection marker in the diagnosis of acute appendicitis. Similar to the literature, it has been shown that the CRP level, which was high before the operation, gradually decreased after the operation, but still did not return to normal at discharge. The decrease in CRP and WBC values after surgery is an indication that inflammation has regressed after appendectomy, but it takes time to completely return to normal.