C-Reactive Protein in Ovarian Torsion
Yes, C-reactive protein (CRP) is elevated in ovarian torsion, with studies showing significantly higher levels in patients with ovarian torsion compared to controls. 1
Evidence for CRP Elevation in Ovarian Torsion
In an experimental rat model study, plasma high-sensitivity CRP (hs-CRP) levels were significantly higher in the ovarian torsion group compared to the control group (0.91 ± 0.18 vs. 0.39 ± 0.06 mg/l, p < 0.001) following 2 hours of ovarian torsion 1
The sensitivity and specificity of hs-CRP for detecting ovarian torsion were both calculated as 100% at a cut-off value of >0.275 mg/l in this experimental model 1
Clinical studies have confirmed that elevated CRP levels are associated with ovarian torsion in humans, with CRP being one of the significant predictive factors for this condition 2
Relationship Between CRP and Ovarian Necrosis
CRP levels are significantly higher in patients with necrotic ovaries due to torsion compared to those with normal ovaries 3
The sensitivity and specificity of CRP level for detecting ovarian necrosis were 35% and 83%, respectively, with positive and negative predictive values of 38% and 82% 3
Lower CRP levels (<0.3 mg/dl) are associated with better potential for ovary conservation in suspected ovarian torsion cases 3
Clinical Application and Diagnostic Value
CRP elevation, along with vomiting and short duration of abdominal pain, has predictive value for the diagnosis of ovarian torsion in children 2
When comparing ovarian torsion with ruptured ovarian cysts, significant differences in CRP levels have been observed (0.9 mg/dL vs 6.6 mg/dL, respectively; p<0.01) 4
CRP is one of several inflammatory biomarkers that can be used in the diagnostic workup of ovarian torsion, with CRP having high specificity (88%) for the condition 5
Limitations and Considerations
While CRP is elevated in ovarian torsion, it is a non-specific marker of inflammation that can be elevated in many other conditions 6
CRP levels may vary based on the duration of torsion, with higher levels typically seen with longer duration of symptoms 3
Other inflammatory markers, such as white blood cell count and D-dimer levels, should also be considered alongside CRP in the diagnostic evaluation of suspected ovarian torsion 5
The timing of CRP measurement is important, as levels may continue to rise with ongoing ischemia and inflammation 1, 3
Clinical Decision Making
In patients presenting with acute pelvic pain and suspected ovarian torsion, elevated CRP should prompt consideration of urgent surgical intervention, especially when combined with other clinical features such as vomiting and short duration of pain 2
CRP levels, combined with imaging findings and clinical presentation, can help differentiate ovarian torsion from other causes of acute abdomen 4
For patients with ovarian cysts and acute abdominal pain, the combination of elevated CRP, cyst size >5 cm, and presence of nausea/vomiting strongly suggests ovarian torsion and warrants urgent surgical evaluation 4, 5