Acute Phase Proteins Efficacy in Differential Diagnosis of Acute Scrotum

Introduction: Evaluating patient with acute scrotum is based on medical history (e.g. age), physical examination, blood tests, urine analysis and imaging studies. Differential diagnosis may be difficult. Efficacy of serum acute phase proteins in patients with acute scrotum was assessed in this study.

Materials and Methods: 45 patients were recruited and allocated within three sub-groups; acute epididimitis & epididmorchitis (n=26), torsion of testis (n=9),and other disorders that presented with acute scrotum  such as miscellaneous, varicocele ,hydrocele ,scrotal trauma and torsion of testicular appendages (n=10) and a group of non-acute, non-inflammatory referrals were selected as a control (n=20). Level of α1 antitrypsin, haptogloubin, CRP and fibrinogen was measured in all cases. Results were compared with standard clinical findings and routine blood or urine testes levels using ANOVA statistic.

Results: There was no significant difference for mean level of α₁ antitrypsin between the groups according to ANOVA statistical analysis (P=0.234). Mean haptogloubin level in the groups one, two, three and four was 1347.92, 418.33, 525.60 and 973.5 mg/l respectively and there was significant difference between the groups (P<0.001). Group one had significantly higher level of haptogloubin level than groups two and three (P<0.001 and p=0.001). There was no significant difference between group two and three also between all patient groups with control.  Mean CRP level in groups one, two, three and four was 102.47, 12.45, 17.57 and 1.59 mg/l respectively and difference  between the groups were statistically significant (P=0.001). With respect to CRP level comparison of the groups, in group one it was significantly higher than  groups two, three and four (P<0.001). There was no significant difference for CRP level between other groups. Mean fibrinogen level in groups one, two, three and four was 3.06, 3.07, 2.14 and 2.9 g/l respectively and there was no significant difference with each other (P=0.533). Fibrinogen and α1 antitrypsin could not help differentiating patients from each other as well as control group.

Conclusion:Findings confirmed that CRP, and haptogioubin are useful biomarkers in differential diagnosis of acute scrotum. In the presence of any doubt, irrespective to imaging result and acute phase proteins level, surgical operation for ruling out of torsion is necessary. In conclusion the greatest value of these biomarkers is for confirmation of the absence of testicular torsion, which in this condition surgical intervention seems will not be necessary.