The potential role of interleukin-6, endotoxin, and C-reactive protein as standard biomarkers for acute appendicitis in adults

Introduction/Objective Acute appendicitis (AA) is by far the most frequent urgent condition in abdominal surgery and numerous biomarkers may help the physician to diagnose and even predict the severity of the disease. The objective of the paper was to determine the accuracy of C-reactive protein (CRP), interleukin-6, and endotoxin level and compare it with the diagnostic value of Alvarado score (AS) in adults surgically treated for AA. Methods Sixty-seven patients were diagnosed with AA using AS. Prior to surgery serum levels of inflammatory biomarkers were determined and together with AS were respectively compared to the results of histopathological analysis of specimens. The patients were divided into three group according to the histopathological assessment. Results The univariate analysis revealed that the increase of CRP level by one unit increases the probability of complicated AA (CoAA) occurrence by 1% (1.00-1.02, p < 0.05). ROC curve analysis has revealed that CRP has better capacity to predict suppurative AA (SAAs)/CoAAs than catarrhal AA (CAA), with the cut-off value of 19.45. The increase of AS value by one unit produced 2.98-fold increase of the probability of CoAA occurrence (1.60-5.57, p < 0.001), while positive AS value increases the probability of CoAA occurrence 24.67 times (4.94-123.12; p < 0.001). ROC curve analysis demonstrated that AS may predict CoAAs better than CAAs/SAAs, with the cut- off value of 8.50. Conclusion AS and CRP should be routinely used combined as powerful tools for the diagnosis and prediction of complicated AA.