Acute appendicitis; clinical features, haematological parameters, biochemical markers, histopathological diagnoses and associations

Introduction: Acute appendicitis is a global problem requiring timely surgical intervention to prevent serious complications. Correct diagnosis of appendicitis remains a challenge as clinical features, and laboratory findings vary in majority of patients. The aim of the study was to determine the association of clinical features, biochemical markers and haematological parameters with histopathological diagnosis in patients with acute appendicitis in National Hospital Galle.
Methods: This is a descriptive, cross-sectional study carried out among 380 patients selected using convenient sampling method. The data were obtained by the retrospective review of medical records of the patients who were diagnosed with acute appendicitis and underwent appendicectomy in all five surgical units in National Hospital Galle from June 2022 to June 2024. Association of clinical features, biochemical markers and haematological parameters with histopathological diagnoses were assessed using standard statistical tests.
Results: Among the 380 patients, 95% (n=361) had histopathologically confirmed acute appendicitis. Significant associations were found between histopathological diagnosis and typical abdominal pain (p=0.042), anorexia (p=0.032), nausea (p=0.007), rebound tenderness (p=0.004), elevated CRP (p=0.039), WBC (p=0.045), and neutrophil counts (p=0.049). CRP, WBC, and neutrophil count had very high positive predictive values for acute appendicitis; 97.63%, 96.87% and 95.63% respectively. There were significant differences in mean values of CRP, WBC and neutrophil counts between uncomplicated and complicated cases of acute appendicitis; (p=0.001), (p=0.003) and (p=0,002) respectively.
Conclusions and Recommendations: Certain clinical features, elevated CRP, WBC, and neutrophil counts were significantly associated with acute appendicitis. Integrating these laboratory markers with clinical symptoms enhances diagnostic accuracy, helping to identify high-risk cases. Elevated CRP level, WBC and neutrophil counts were helpful to distinguish complicated cases from uncomplicated. This approach can reduce misdiagnosis and unnecessary surgical procedures, improving patient outcomes and clinical decision-making   in acute appendicitis management.