Association between White Blood Cell Count, C-Reactive Protein, and Complications of Acute Appendicitis: A Retrospective Cohort Study

Abstract Background: Acute appendicitis is a common surgical emergency, and early identification of complications such as perforation and gangrenous changes is crucial for optimal management. This study evaluates the association of white blood cell (WBC) count and C-reactive protein (CRP) levels with perforation and gangrenous appendicitis. Methods: A retrospective analysis of 129 patients who underwent appendectomy was conducted. Laboratory values (WBC and CRP) were compared between uncomplicated and complicated (perforated/gangrenous) cases. Results: Perforation was present in 34.1% (44/129) and gangrenous changes in 14.7% (19/129). Mean WBC was significantly higher in perforated (14.7 vs. 12.7, p < 0.01) and gangrenous cases (16.4 vs. 12.9, p < 0.01). CRP was markedly elevated in perforation (113.5 vs. 22.1 mg/L, p < 0.001) and gangrenous appendicitis (138.6 vs. 42.5 mg/L, p < 0.001). A CRP >50 mg/L had 68.2% sensitivity and 85.9% specificity for perforation, while a WBC >15 ×10⁹/L had 41.5% sensitivity and 77.6% specificity. Conclusion: Elevated CRP and WBC are strongly associated with complicated appendicitis. CRP is a more discriminative marker than WBC for perforation and gangrenous changes. These findings support the use of CRP in risk stratification for surgical decision-making. Keywords: Appendicitis, perforation, gangrenous, WBC, CRP, biomarkers.