Skip to main content
SpringerLink
Log in

Is C-reactive protein a reliable test for suspected appendicitis in extremely obese children?

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

The diagnosis of acute appendicitis by physical examination can sometimes be difficult in extremely obese children. C-reactive protein (CRP) is commonly used to support the clinical diagnosis of appendicitis. However, obesity has been widely recognized as a chronic inflammatory condition and associated with elevated inflammatory indicators including CRP. The aim of this study was to examine the association between obesity and CRP levels in extremely obese children presenting with suspected appendicitis.

Materials

The hospital records of 947 consecutive patients, who underwent appendectomy for acute appendicitis between 2002 and 2008 were retrospectively analyzed. 164 children (17.3%) were extremely obese. Extreme obesity was defined, as greater than two standard deviations above the standardized mean weight for age. The diagnostic value of CRP level was compared between extremely obese and non-obese children.

Results

The incidence of histologically normal appendix was significantly higher in extremely obese children [42 out of 164 (25.6%)] compared to non-obese children [85 out of 783 (10.8%) (P < 0.001)]. The mean CRP levels were significantly higher in extremely obese children with histologically normal appendix compared to non-obese children with normal appendix (P < 0.001). The specificity and the positive predictive value were significantly lower in the extremely obese children group than in the non-obese group (P < 0.001).

Conclusion

CRP is not a reliable marker of inflammation in extremely obese children presenting with suspected appendicitis. Our data highlight the importance of obesity when interpreting the significance of an elevated CRP level in children with suspected diagnosis of appendicitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Slyper AH (2004) The pediatric obesity epidemic: causes and controversies. J Clin Endocrinol Metab 89:2540–2547

    Article  CAS  PubMed  Google Scholar 

  2. Rothrock SG, Pagane J (2000) Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 36:39–51

    Article  CAS  PubMed  Google Scholar 

  3. Wisse BE (2004) The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol 15:2792–2800

    Article  CAS  PubMed  Google Scholar 

  4. Visser M, Bouter LM, McQuillan GM et al (2001) Low-grade systemic inflammation in overweight children. Pediatrics 107:e13

    Article  CAS  PubMed  Google Scholar 

  5. Valerio G, Scalfi L, Martino C et al (2003) Comparison between different methods to assess the prevalence of obesity in sample of Italian children. J Pediatr Endocrinol Metab 16:211–216

    CAS  PubMed  Google Scholar 

  6. Davies D, Yanchar NL (2007) Appendicitis in the obese child. J Pediatr Surg 42:857–861

    Article  PubMed  Google Scholar 

  7. Puylaert JBCM (1986) Acute appendicitis: US evaluation using graded compression. Radiology 158:355–360

    CAS  PubMed  Google Scholar 

  8. Josephsson T, Styraud J, Eriksson S (2000) Ultrasonography in acute appendicitis. Body mass index as selection factor for US examination. Acta Radiol 41:486–488

    Google Scholar 

  9. Hörmann M, Scharitzer M, Stadtler A et al (2003) Ultrasound of the appendix in children: is the child too obese? Eur Radiol 13:1428–1431

    PubMed  Google Scholar 

  10. Wu HP, Lin CY, Chang CF et al (2005) Predictive value of C-reactive protein at different cutoff levels in acute appendicitis. Am J Emerg Med 23:449–453

    Article  PubMed  Google Scholar 

  11. Beltran MA, Almonacid J, Vicencio A et al (2007) Predictive value of white blood cell count and C-reactive protein in children with appendicitis. J Pediatr Surg 42:1208–1214

    Article  PubMed  Google Scholar 

  12. Vidal E, Carlin E, Driul D et al (2006) A comparison study of the prevalence of overweight and obese Italian preschool children using different reference standards. Eur J Pediatr 165:696–700

    Article  PubMed  Google Scholar 

  13. Luciano A, Livieri C, Di Pietro ME et al (2003) Definition of obesity in childhood: criteria and limits. Minerva Pediatr 55:453–459

    CAS  PubMed  Google Scholar 

  14. O`Neil JL, McCarthy SN, Burke SJ et al (2006) Prevalence of overweight and obesity in Irish school children, using four different definitions. Eur J Clin Nutr 61:743–751

    Article  Google Scholar 

  15. Fontana L, Eagon C, Trujillo ME et al (2007) Visceral fat adipokine secretion is associated with systemic inflammation in obese humans. Diabetes 56:1010–1013

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The National Children’s Hospital, Dublin, Dublin 24, Ireland

    Balazs Kutasy, Ganapathy Laxamanadass & Prem Puri

Authors
  1. Balazs Kutasy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ganapathy Laxamanadass
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Prem Puri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prem Puri.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kutasy, B., Laxamanadass, G. & Puri, P. Is C-reactive protein a reliable test for suspected appendicitis in extremely obese children?. Pediatr Surg Int 26, 123–125 (2010). https://doi.org/10.1007/s00383-009-2511-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-009-2511-y

Keywords

Search

Navigation