Year: 2026 | Month: April | Volume: 16 | Issue: 4 | Pages: 143-155
DOI: https://doi.org/10.52403/ijhsr.20260419
Comparative Diagnostic Performance of Procalcitonin, C-Reactive Protein, and White Blood Cell Count in Acute Appendicitis: A PRISMA-Compliant Systematic Review
Abhishek Prasad1, Sai Sharan2, Aditya Awati3
1Assistant Professor, Department of General Surgery, MR Medical College, Kalaburagi, Karnataka, India.
2Senior Resident, Department of General Surgery, ESIC Medical College, Kalaburagi, Karnataka, India.
3Assistant Professor, Department of General Surgery, ESIC Medical College, Kalaburagi, Karnataka, India.
Corresponding Author: Abhishek Prasad
ABSTRACT
Background and Aims: Acute appendicitis remains a common surgical emergency, and timely diagnosis is essential to prevent complications. Inflammatory biomarkers such as procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) count are frequently used as adjunctive diagnostic tools; however, their comparative diagnostic accuracy, particularly for complicated appendicitis, remains uncertain. This systematic review aimed to evaluate and compare the diagnostic performance of PCT, CRP, and WBC, individually and in combination, for detecting overall and complicated acute appendicitis in adult and pediatric patients, using histopathology as the reference standard.
Methods: This review was conducted according to PRISMA guidelines. A comprehensive search of PubMed/MEDLINE, ScienceDirect, the Cochrane Library and Google Scholar from 2012 to 2025 was performed using MeSH terms and keywords combined with Boolean operators “AND” and “OR”. Eligible studies included prospective and retrospective diagnostic accuracy studies assessing PCT, CRP, and/or WBC against histopathological findings. Data on sensitivity, specificity, predictive values, area under the curve (AUC), and cut-off values were extracted. Methodological quality was assessed using the QUADAS-2 tool.
Results: Nine observational studies comprising adult and pediatric populations were included. CRP demonstrated consistently moderate-to-high sensitivity and superior performance in identifying complicated or perforated appendicitis, with reported AUC values up to 0.93. PCT showed limited sensitivity for uncomplicated appendicitis but strong predictive value for complicated disease, including abscess and perforation. WBC count exhibited relatively high sensitivity but limited specificity. Combined biomarker strategies improved diagnostic accuracy and negative predictive value compared with individual markers.
Conclusion: CRP is the most reliable single biomarker for acute appendicitis, particularly for detecting complicated disease. PCT is valuable for severity assessment, while WBC serves as a supportive indicator. Combined biomarker approaches enhance diagnostic performance but do not replace clinical evaluation.
Key words: Appendicitis; Procalcitonin; C-Reactive Protein; Leukocyte Count; Sensitivity and Specificity; Diagnostic Accuracy.