Role of Serum C-Reactive Protein (CRP) for Improving the Diagnostic Performance of Modified Alvarado Score in Suspected Acute Appendicitis at Tertiary Care Hospital

Background: Acute appendicitis is one of the most common surgical emergencies, yet its diagnosis can be challenging due to variable clinical presentations. The Modified Alvarado Score (MAS) is widely used for assessment, but its diagnostic accuracy is not always optimal. Elevated CRP, an acute-phase reactant, serves as an important biochemical indicator of inflammatory processes. In most, though not all diseases, the circulating value of CRP reflects ongoing inflammation and/or tissue damage much more accurately than do other laboratory parameters of the acute-phase response. To evaluate the combined effect of CRP and MAS in accurate diagnosis of Acute Appendicitis. Materials and methods: This was a descriptive type of observational study conducted in the Department of Surgery, Chittagong Medical College Hospital. After fulfilling the selection criteria, 100 individuals with a clinical diagnosis of acute appendicitis were included in the study. Before operative intervention, each patient’s Alvarado score and serum CRP concentration were assessed. Histopathological examination of the resected appendix was used to confirm or exclude the diagnosis of acute appendicitis. Results: The mean age of the patients was 24.5 (±8.9) years where majority (54.0%) cases were male. Among the 100 patients, 75% of patients had raised CRP (>6mg/L) and 78% of patients had Modified Alvarado score ≥7. According to histopathological assessment of the appendectomy specimen, 77.0% were positive and 23.0% were negative for acute appendicitis. Acute appendicitis was identified in 78.0% of cases by MAS (Score ≥7) 75.0% by elevated CRP (>6mg/L), and 73.0% by the combined MAS and CRP criteria. The sensitivity and specificity of MAS were 90.9% and 65.2% respectively. The sensitivity and specificity of CRP were 85.7% and 60.8% respectively. The combined use of CRP and the Modified Alvarado Score demonstrated a sensitivity of 92.0% and a specificity of 91.3%. Conclusion: Using CRP together with the Modified Alvarado Score offers better diagnostic performance than either parameter alone, resulting in improved sensitivity and specificity for diagnosing acute appendicitis. IAHS Medical Journal Vol 9(1), June 2026; 62-67