Again, in patients in Groups B and C, 113 (76.35%) had both WBC and CRP value increase and 9 patients had both values in the normal range. Combining all three parameters (WBC, CRP and percentage of neutrophil count) had positive results for the appendicitis

in 101 (68.24%) patients (Groups B and C), and only 5 patients had one or more values in the normal range. In Group A, only five patients had all the three values increase and 13 patients had one or more values in the normal range. The combined WBC and CRP had a sensitivity, specificity, and positive predictive value of 95.3%, 91.1%, and 95.8%, respectively. ITF2357 in vitro While the combined percentage of the neutrophil count and CRP had a sensitivity, the specificity and positive predictive value of 94.3%, 91.1%, and 95.2%, respectively. Combined all the three parameters (WBC, CRP, and percentage of neutrophil count) gave the sensitivity, and specificity of 95.3% and 91.9%, respectively. The positive predictive value was 95.3% (Table 2). Table 2 Diagnostic accuracy, sensitivity, specificity, and positive (PPV) of white blood cell (WBC) count, C-reactive protein (CRP), percentage of neutrophil (PN) and combined

WBC, CRP and PN in diagnosing acute appendicitis Indices of diagnostic values Diagnostic method Diagnostic accuracy Sensitivity (%) Specificity (%) PPV (%) CRP 83.2 85.1 72 94.7 WBC 82.6 85.1 68 94 PN 77.5 79.1 68 93.6 CRP + LEU 90.1 92.6 75 95.8 CRP + PN 91.1 94.3 72 95.2 LEU + PN 87.1 89.9 71.4 94.7 CRP + LEU + PN 91.9 95.3 91.9 Anti-infection Compound Library price 95.3 Discussion The positive CRP is more accurate than the WBC and neutrophil counts and combined together it further improves diagnostic accuracy [10]. In a double blind study Asfar et al. (2000) reported a sensitivity and specificity of CRP as 86.6% Carnitine palmitoyltransferase II and 93.6%, respectively. They concluded that a normal CRP value probably indicates a normal non-inflamed appendix [14]. It is a more sensitive test than the WBC and neutrophil counts and their combined usage significantly increases sensitivity

and specificity. Erkassap (2000) in a positive study on 102 patients reported that sensitivity and specificity of the CRP were 96% and 78%, respectively; the positive predictive value was 100% [27]. In a retrospective study, Wu and coworkers (2005) concluded that the combined usage of the WBC, neutrophil count, and the CRP monitoring increased the positive predictive value [28]. Grönroos (1999) in his study concluded that when both the WBC and CRP are normal, acute appendicitis is very unlikely [29]. In our study, the rate of complicated appendicitis at admission to the hospital was very high (Table 1). 112 (64.7%) patients had a ruptured/perforated/gangrenous appendix. The rate of perforated appendicitis was 12.1%.