@article{f5a3dbaaae9c45f6be013e902b20b2a6,
title = "Normal inflammatory markers and acute appendicitis: a national multicentre prospective cohort analysis",
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",
author = "{de Jonge}, J. and Scheijmans, {J. C. G.} and {van Rossem}, {C. C.} and {van Geloven}, {A. A. W.} and Boermeester, {M. A.} and Bemelman, {W. A.} and {On behalf of the Snapshot Appendicitis Collaborative Study group} and {van Acker}, {G. J.} and B. Akkermans and Akkersdijk, {G. J.} and Algie, {G. D.} and Allema, {J. H.} and Andeweg, {C. S.} and N. Appeldoorn and {van Baal}, {J. G.} and {den Bakker}, {C. M.} and Bartels, {S. A.} and {van den Berg}, C. and B. Boekestijn and {den Boer}, {F. C.} and D. Boerma and {van den Boom}, {A. L.} and Boute, {M. C.} and Bouwense, {S. A.} and J. Bransen and {van Brussel}, {F. A.} and Busch, {O. R.} and {de Castro}, {S. M.} and Cense, {H. A.} and C. Croese and {van Dalen}, T. and I. Dawson and {van Dessel}, E. and R. Dettmers and N. Dhar and Dohmen, {F. Y.} and {van Dongen}, {K. W.} and {van Duijvendijk}, P. and Dulfer, {R. R.} and Dwars, {B. J.} and Eerenberg, {J. P.} and {van der Elst}, M. and {van den Ende}, E. and Fassaert, {L. M.} and J. Groot and {van Heurn}, E. and Lases, {S. S.} and B. Mirck and {van der Peet}, {D. L.} and {Terwisscha van Scheltinga}, C. and E. Westerduin",
note = "Funding Information: We would like to thank our collaboration group for cooperation and help with data collection. Members of the Snapshot Appendicitis Collaborative Study group are: Van Acker GJ, Akkermans B, Akkersdijk GJ, Algie GD, Allema JH, Andeweg CS, Appeldoorn N, van Baal JG, den Bakker CM, Bartels SA, van den Berg C, Boekestijn, B, den Boer FC, Boerma D, van den Boom AL, Boute MC, Bouwense SA, Bransen J, van Brussel FA, Busch OR, de Castro SM, Cense HA, Croese, C, van Dalen T, Dawson I, van Dessel E, Dettmers R, DharN, Dohmen FY, van Dongen KW, van Duijvendijk P, Dulfer RR, Dwars BJ, Eerenberg JP, van der Elst M, van den Ende E, Fassaert LM, Fikkers JT, Foppen, JW, Furnee, EJ, Garssen FP, Gerhards MF, van Goor H, de Graaf JS, Graat LJ, Groot J, van der Ham AC, Hamming JF, Hamminga JT, van der Harst E, Heemskerk J, Heijne A, Heikens JT, Heineman E, Hertogs R, van Heurn E, van den Hil LC, Hooftwijk AG, Hulsker CC, Hunen DR, Ibelings MS, Klaase JM, Klicks R, Knaapen L, Kortekaas RT, Kruyt F, Kwant S, Lases SS, Lettinga T, Loupatty A, Matthijsen RA, Minnee RC, Mirck B, Mitalas L, Moes D, Moorman AM, Nieuwenhuijs VB, Nieuwenhuijzen GAP, Nijk PD, Omloo JM, Ottenhof AG, Palamba HW, van der Peet DL, Pereboom IT, Plaisier PW, van der Ploeg AP, Raber MH, Reijen MM, Rijna H, Rosman C, Roumen RM, Scmitz RF, Schouten van der Velden AP, Scheurs WH, Sigterman TA, Smeets HJ, Sonnevled DJ, Sosef MN, Spoor SF, Stassen LP, van Steensel L, Stortelder E, Straatman J, van Susante HJ, Suykerbuyk de Hoog DE, Terwisscha van Scheltinga C, Toorenvliet BR, Verbeek PC, Verseveld M, Volders JH, Vriens MR, Vriens PW, Vrouenraets BC, van de Wall BJ, Wegdam JA, Westerduin E, Wever JJ, Wijfels NA, Wijnhoven BP, Winkel TA, van der Zee DC Zeillemaker AM, Zietse C The datasets generated and analysed during the current study are not publicly available due to possible compromising individual privacy but are available from the corresponding author on reasonable request. Publisher Copyright: {\textcopyright} 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = jul,
doi = "https://doi.org/10.1007/s00384-021-03933-7",
language = "English",
volume = "36",
pages = "1507--1513",
journal = "International journal of colorectal disease",
issn = "0179-1958",
publisher = "Springer Verlag",
number = "7",
}