Hyperbilirubinaemia alone cannot distinguish a perforation in acute appendicitis

Silva, Fábio R.; Rosa, Maria Inês da; Silva, Bruno Rodrigues; Simon, Carla Sasso; Alexandre, Maria Cecília Manenti; Medeiros, Lídia Rosi; Bitencourt, Fabricio Souza; Reis, Maria Eduarda Fernandes dos

doi:10.1111/ans.12989

Cited by 15 publications

(17 citation statements)

References 27 publications

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“…Adams and Jaunoo 14 reported that there was no significant difference in pre-operative bilirubin levels between the perforated appendicitis cases and the non-perforated appendicitis cases (P=.326). In meta-analysis by Silva et al 15…”

Section: T a B L E 1 Demographic Characteristics And Hematologic Markmentioning

confidence: 99%

“…10,11 Elevated serum bilirubin (total bilirubin >1.0 mg/dL) has been noted to be a new marker for appendiceal perforation, but studies disagree on its sensitivity and specificity. [12][13][14][15][16] C-reactive protein (CRP) was reported to be superior to bilirubin for anticipation of perforation in acute appendicitis. 17 Neutrophil-to-lymphocyte ratio (NLR) was introduced as a predictor of complicated appendicitis, but their sensitivity and specificity is not better than that of bilirubin or CRP.…”

Section: Introductionmentioning

confidence: 99%

“…Pooled sensitivity was 54.6% (95% CI, 42.8-65.8) and specificity was 70.0% (95% CI, 54.7-81.9%) and an AUC of 0.65 on summary ROC curves. 15 DNI should be a best biomarker, so far, to differentiate between non-perforated and perforated appendicitis among elderly patients.…”

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confidence: 99%

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Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly

Shin

Cho

Kim

et al. 2017

Clinical Laboratory Analysis

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Background Delta neutrophil index (DNI) is a new inflammatory marker and the present study aimed to evaluate the predictive value of the DNI for the presence of a perforation in elderly with acute appendicitis. Methods This retrospective observational study was conducted on 108 consecutive elderly patients (≥65 years old) with acute appendicitis treated over a 24‐month period. Results Sixty‐nine of the 108 patients (median, IQR: 72, 67‐77 years) were allocated to the perforated appendicitis group (63.9%) and 39 to the non‐perforated appendicitis group (36.1%). WBC, neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio and DNI were significantly higher in the perforated group. In multiple logistic regression analyses, initial DNI was the only independent marker that can significantly predict the presence of perforation in multiple regression [odds ratio 9.38, 95% confidence interval (2.51‐35.00), P=.001]. Receiver operator characteristic curve analysis showed that DNI is a good predictor for the presence of appendiceal perforation at an optimal cut‐off for DNI being 1.4% (sensitivity 67.7%, specificity 90.0%, AUC 0.807). Conclusion Clinicians can reliably differentiate acute perforated appendicitis from non‐perforated appendicitis by DNI level of 1.4 or more in elderly patients.

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Section: T a B L E 1 Demographic Characteristics And Hematologic Markmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly

Shin

Cho

Kim

et al. 2017

Clinical Laboratory Analysis

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“…A CRP level of over 50 mg/dL was found to be an independent predictor of perforation . McGowan et al .…”

Section: Predicting the Progression To Perforation Or Appendectomy Inmentioning

confidence: 96%

Should the non‐operative management of appendicitis be the new standard of care?

Gandy

Wang

2016

ANZ Journal of Surgery

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Appendicitis is one of the most commonly encountered emergency presentations to the general surgical services. The operative management of this condition is associated with significant financial costs and represents a significant workload on the emergency surgical services. Negative appendicectomy rates remain high (20-25%) despite advancements in laboratory testing and imaging techniques. Recent data from randomized controlled trials suggests that non-operative management in patients presenting with uncomplicated or nonperforated acute appendicitis is a viable alternative, with only 23% of patients requiring an appendicectomy at 1 year and an overall reduction in complications. In view of this, the traditional teaching of mandatory appendicectomy for all patients with acute appendicitis should be challenged. This article briefly reviews the evidence that supports the use of diagnostic tests to reduce the negative appendicectomy rate and examines the potential selection criteria for non-operative management. The data raises the questions: can a 20-25% negative appendicectomy rate be defended as best practice and can the traditional dogma of early appendicectomy to prevent perforation be supported?Appendicitis is one of the most common causes of abdominal pain, especially in children and young adults. The lifetime risk of appendicitis is one in 13. A total of 88% of emergency surgical admissions that require surgery are cases of appendicitis. In Australia, over 28 000 cases of appendicitis are reported each year, but only 5% of these are complicated (perforation, phlegmon or generalized peritonitis).1 It has been postulated that uncomplicated and complicated appendicitis may have different pathophysiology and that most uncomplicated cases will resolve without an appendicectomy. 2-4The pathophysiology of appendicitis, whether it is due to luminal obstruction by faecolith, lymphoid hyperplasia, parasite or rarely tumour, is similar to colonic diverticulitis. Andersson et al. observed that the proportion of complicated cases remains constant over time from onset of symptoms, but the proportion of patients with uncomplicated appendicitis falls (Fig. 1). 4 This evidence suggests that not all appendicitis will progress to perforation without treatment. So, the notion of operating early on all patients with uncomplicated appendicitis, to prevent perforation, does not hold water. The impact of appendiceal perforation in terms of morbidity and mortality is now also relatively low, in comparison with the historical, pre-antibiotic era. Appendicectomy can be delayed by up to 24 h in nearly all cases without compromising outcomes. 5-7The treatment of acute colonic diverticulitis (with similar pathophysiology to acute appendicitis) is primarily non-operative with surgery reserved for the overtly septic, those not resolving or significant complications. The reason for this is not due to pathogenesis, but that surgery for acute diverticulitis involves a higher risk of complications and greater consequences for the patie...

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“…The first is a negative study by Silva et al . In this study, they look at the role of hyperbilirubinaemia in predicting the risk of perforation in appendicitis. The theoretical basis for this is the notion that aggressive appendicitis may cause a portal pyaemia or endotoxaemia that may impair bilirubin excretion.…”

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confidence: 99%

Appendicitis: ‘to operate or not?’ Should that be the question?

Truskett

2016

ANZ Journal of Surgery

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Hyperbilirubinaemia alone cannot distinguish a perforation in acute appendicitis

Abstract: This meta-analysis showed that the value of hyperbilirubinaemia alone cannot predict acute perforated appendicitis.

Cited by 15 publications

References 27 publications

Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly

Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly

Should the non‐operative management of appendicitis be the new standard of care?

Appendicitis: ‘to operate or not?’ Should that be the question?

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