Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study

Abstract

Background: Appendicitis is the most common acute abdominal condition requiring emergency surgery, with a lifetime risk of 6%. Appendectomy continues to be one of the commonest procedures in general surgery, accounts for approximately 1% of all surgical operation. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%). The aim of this study was to whether Serum Bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about complicated appendicitis.Methods: This was prospective observational study done in Mahatma Gandhi Medical College and Research Institute, Pondicherry between November 2014 and August 2016. About 110 patients of acute appendicitis who had undergone appendicectomy were studied. Data was collected and analyzed critically.Results: Males 66 (60%) outnumbered females 44 (40%) and overall mean age was 26.61±12.37 years. Of the 110 patients, 9% were normal appendix, 59.09% were confirmed as acute appendicitis while 31.81% were diagnosed with complicated appendicitis on biopsy. The Sensitivity and Specificity of serum bilirubin as a marker in predicting Acute appendicitis and complicated appendicitis was 47.6% and 90.9% respectively. Similarly, the Positive predicative value and Negative predicative value for the same was 88.5% and 61.5% respectively with odds ratio 12.4 with significant p value <0.0001.Conclusions: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia should be identified as having a higher probability of complicated appendicitis. Hence, serum bilirubin levels have a predictive potential for the diagnosis of severity of acute appendicitis and need for early appendicectomy. If total serum bilirubin is added to already existing laboratory tests, then the diagnosis of complicated appendicitis in clinically suspected cases can be made with fair degree of accuracy, the need for CECT and MRI can be reduced and unnecessary delay in appendicectomy can be avoided.

Predictive value of total leucocyte count (TLC), bilirubin and C-reactive protein in the diagnosis of gangrenous and perforated appendicitis.

“…According to this study bilirubin more than 1 mg/dl was seen in 2 (3.4%), 25 (43.2%) and 31 (53.4%) of cases respectively with p value less than 0.05 and over all sensitivity of 94$, specificity of 66.66%, PPV of 88.5% and NPV of 80%. 26 In another study by Estrada et al odd ration see for association of hyperbilirubinemia with perforated appendicitis was seen as 2.96 (95% CI, 1.11-7.6) with p value of 0.031. 27 According to a retrospective analysis done by Emmanuel et al in 2011 found that hyper bilirubinemia was significantly high in cases that presented with mean longer duration of time with p value of 0.001 and specificity was seen in 88% of the cases.…”

“…6 Approximately 50% of cases of gangrenous or perforated appendicitis are associated with a faecolith in contrast with DOI: 10.29309/TPMJ/2019. 26 2 uncomplicated appendicitis in which a faecolith is rarely present. 7 Most of the cases of acute appendicitis are diagnosed by Alvarado score 7 and above.…”

Elevated serum bilirubin in acute appendicular perforation as a newer serum marker: a diagnostic validation test

“…The mean age of presentation being 30.7±12.2 years in males and 30.8±14.1 years in females respectively, this was consistent with the quoted incidence of Appendicitis in the literature where it is most frequently seen in patients in their second through fourth decades of life. 17 In our study population of 100 patients, 75 patients (75%) were diagnosed as acute appendicitis pre-operatively while 25 patients (25%) were diagnosed with appendicular perforation. On confirmation with histopathological reports (HPR) post-operatively 59 patients (59%) were acute appendicitis case and 41 patients (41%) of appendiceal perforation as diagnosis.…”

Role of serum bilirubin in predicting the severity of acute appendicitis

“…Cheekuri et al in 2017 conducted a prospective study Hyperbilirubinemia as a predictor of the severity of acute appendicitis-an observational study with sample size of 110 showed results of sensitivity 94%, specificity 66%, PPV 88.5%, NPV 80%. 1 D'souza et al conducted a prospective study Bilirubin; a diagnostic marker for appendicitis with sample size of 143 showed results of sensitivity 70%, specificity 82%, PPV 47%, NPV 93%. 3 S. Khan in 2008 conducted a prospective study of total bilirubin levels in appendicitis with sample size of 110 showed a results of sensitivity 87%, specificity 100%, PPV 100%, NPV 17.3%.…”