Ovarian Torsion and CRP Elevation
Yes, ovarian torsion can increase CRP levels, but the elevation is typically modest and occurs later in the disease course, particularly when ovarian necrosis develops.
CRP Elevation Pattern in Ovarian Torsion
The relationship between ovarian torsion and CRP is nuanced and depends on timing and tissue viability:
Early torsion (< 10 hours) typically shows minimal CRP elevation, with mean levels around 0.9 mg/dL in patients with ovarian torsion, which is significantly lower than other acute abdominal conditions 1, 2.
CRP elevation becomes more pronounced with ovarian necrosis, as the inflammatory response intensifies with tissue death 1. In experimental models, CRP levels increased significantly (0.91 ± 0.18 mg/L vs. 0.39 ± 0.06 mg/L in controls) after 2 hours of torsion 3.
Elevated CRP (> 0.3 mg/dL) is associated with decreased likelihood of ovarian conservation, suggesting more advanced tissue damage 1. The sensitivity of CRP for detecting ovarian necrosis is only 35%, but specificity is 83% 1.
Clinical Diagnostic Algorithm
When evaluating suspected ovarian torsion, CRP should be interpreted within this framework:
Time from symptom onset is critical: Patients presenting within 10 hours of acute pain onset typically have lower CRP levels regardless of torsion severity 1, 2.
CRP helps differentiate torsion from ruptured ovarian cyst: Ruptured cysts show significantly higher CRP elevation (mean 6.6 mg/dL) compared to torsion (mean 0.9 mg/dL), making this a useful distinguishing feature 2.
Normal or minimally elevated CRP does NOT rule out ovarian torsion, especially in early presentation 1, 2. The diagnosis remains primarily clinical and imaging-based 4, 5.
Key Clinical Pitfalls
Do not delay surgical intervention based on normal CRP: Ovarian torsion is a time-sensitive emergency requiring immediate ultrasound and surgical consultation, regardless of inflammatory markers 4, 5.
Elevated neutrophil-to-lymphocyte ratio may be more useful than CRP for early diagnosis 6.
CRP elevation suggests longer duration or necrosis: If CRP is significantly elevated in suspected torsion, this may indicate prolonged ischemia and lower likelihood of ovarian salvage, but detorsion should still be attempted in reproductive-age women 1, 6.
Diagnostic Priority
Ultrasound remains the first-line diagnostic modality, with key findings including enlarged ovary (>4 cm), absent venous flow (100% sensitivity, 97% specificity), and whirlpool sign (90% sensitivity) 4, 5. CRP serves as an adjunctive marker for assessing disease duration and tissue viability, not as a primary diagnostic tool 1, 3, 2.