Role of C-Reactive Protein in Diagnosis and Prognosis of Acute Pelvic Inflammatory Disease: A Prospective Observational Study

Introduction: Acute Pelvic Inflammatory Disease (PID) may present with a variety of clinical manifestations. Early and accurate diagnosis of acute PID is of major importance in reducing the risk of subsequent gynaecological complications inherent to this disease. C-Reactive Protein (CRP) is an acutephase reactant that rises rapidly in response to inflammation and can be used to support the diagnosis, management and prognosis of PID. Aim: To study the role of CRP in the diagnosis and prognosis of acute PID and to compare it with Total Leukocyte Count (TLC) and Erythrocyte Sedimentation Rate (ESR). Materials and Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynaecology, Umaid Hospital, Dr. SN Medical College, Jodhpur, Rajasthan, India, between June 2008 and May 2009. A total of 25 clinically diagnosed patients of acute PID (presenting with abdominal pain, fever, palpable adnexal mass, cervical motion tenderness, and/or unhealthy cervical discharge) were included in the study. Haematological investigations, including CRP, TLC and ESR, were performed. The patients received conservative treatment, and their clinical condition was monitored and associated with CRP, TLC and ESR values, which were repeated on the 3rd, 7th, and 21st days. The p-values were calculated using the paired t-test. Results: The majority of patients (48%) were in the age group of 21-25 years. The mean age at presentation was 27.88±6.20 years. On admission, CRP was elevated in 96% of patients, while TLC and ESR were raised in 64% and 88% of patients, respectively. TLC levels showed a significant decrease (p-value<0.001) by the third day of treatment. Mean ESR levels increased on the third day but decreased significantly (p-value<0.001) between the third and 21st day of treatment; however, they did not return to normal even by day 21. CRP levels decreased significantly (p-value<0.001) on days 3 and 7, while the decline from day 7 to day 21 was less significant (p-value<0.01). By day 21, CRP was undetectable in all patients. Conclusion: CRP was found to be more sensitive than TLC and ESR in supporting the clinical diagnosis of acute PID. Furthermore, compared with TLC and ESR, changes in CRP levels associated more closely with clinical improvement.