Raised faecal calprotectin levels in pateints presenting with right iliac fossa pain warrant mandatory laparoscopy: A non-invasive predictor of acute appendicitis

Background: Despite advances in medical investigation the rates of negative appendicectomy remain unchanged. We investigated whether faecal calprotectin levels (FCP), a bowel lumen inflammatory marker, could accurately diagnose acute appendicitis.

Methods: Sixty-four consecutive patients presenting with RIF pain were recruited. Faecal samples were analysed for FCP by ELISA. All underwent laparoscopy on clinical grounds. FCP levels were compared to white cell count, c-reactive protein, erythrocyte sedimentation rate, temperature and heart rate and correlated with the final diagnosis. The diagnostic accuracy of each parameter was tested using receiver operating characteristic (ROC) curves.

Results: There were 43 (67%) cases of gastrointestinal (GIT) pathology of which 38 (60%) had acute appendicitis. FCP was raised in 14 patients (22%), each of whom had GIT pathology. Raised FCP levels were associated with the presence of GIT pathology (p=0.003). Likelihood ratio calculation and ROC analysis indicate that FCP is second only to leukocytosis in predictive power. In the presence of RIF pain raised FCP has 100% specificity for GIT pathology and 88% specificity for acute appendicitis.

Conclusion: We suggest that a high FCP level indicates definite intra-luminal pathology and in the setting of RIF pain is highly specific for acute appendicitis and warrants mandatory laparoscopy.