Hyperbilirubinemia as a predictor of severity of acute appendicitis

Akai, Masaaki; Iwakawa, Kazuhide; Yasui, Yukihiko; Yoshida, Yusuke; Kato, Takuya; Kitada, Koji; Hamano, Ryosuke; Tokunaga, Naoyuki; Miyaso, Hideaki; Tsunemitsu, Yousuke; Otsuka, Saori; Inagaki, Masaru; Ishibashi, Hiromi

doi:10.1177/0300060519856155

Cited by 30 publications

(21 citation statements)

References 16 publications

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“…Given that the study conducted by Chaudhary et al involved only eight patients with complicated appendicitis and that all of whom had hyperbilirubinemia, the observed high diagnostic efficacy was expected. Recently, Iftikhar et al reported hyperbilirubinemia as a predictor for complicated appendicitis, with a sensitivity of 56.60% and a specificity of 95.45% [ 27 ]. Other recent studies also reported that elevated TBIL levels are associated with later stages of appendicitis [ 13 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Hyperbilirubinemia and Hyponatremia as Predictors of Complicated Appendicitis

Shuaib

Alhamdan²,

Arian

et al. 2022

Medical Sciences

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Several studies have reported elevated serum bilirubin or reduced serum sodium levels in patients with complicated appendicitis (CA). This study examined the efficacy of hyperbilirubinemia, hyponatremia, and both combined in the preoperative diagnosis of CA. Patients who underwent surgery for acute appendicitis were included in this retrospective review. In total, 247 patients were included in the final analysis. Of these, 36 (14.2%) had early appendicitis, 177 (72.0%) had acute suppurative appendicitis, 32 (13.0%) had necrotizing/gangrenous acute appendicitis, and 2 (0.8%) had other types of appendicitis. The mean total bilirubin (TBIL) level was significantly higher in patients with CA than in those with uncomplicated appendicitis. Conversely, the mean serum sodium level was significantly lower in patients with CA than in those with uncomplicated appendicitis. The levels of TBIL (odds ratio: 1.098, 95% CI: 1.052–1.147) and serum sodium (odds ratio: 0.743, 95% CI: 0.646–0.855) were associated with CA. Hyponatremia combined with hyperbilirubinemia yielded significant discriminatory value for the diagnosis of CA. TBIL and serum sodium levels can be considered as adjuvant parameters in the diagnosis of perforated/necrotizing appendicitis. Although hyperbilirubinemia and hyponatremia together were better able to determine the risk of CA than either marker alone, other markers are required to definitively predict CA. Furthermore, large-scale studies are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Hyperbilirubinemia and Hyponatremia as Predictors of Complicated Appendicitis

Shuaib

Alhamdan²,

Arian

et al. 2022

Medical Sciences

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“…The findings suggest that there is a relationship between increased TSB level and acute appendicitis and its complications (20,21) . The risk of perforation increases threefold in patients with TSB levels higher than 1 mg/dL (12) .…”

Section: Discussionmentioning

confidence: 86%

Çocuklarda komplike apandisit tanısında bilirubin ve C-reaktif protein yüksekliğinin değerlendirilmesi

Dursun¹,

Öztaş²

2022

JTAPS

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Objective: Clinical diagnosis of appendicitis is still challenging, as many of its symptoms may be nonspecific and the presentation may be variable, especially in young children. This study aims to investigate the effectiveness of total serum bilirubin (TSB) and C-reactive protein (CRP) in predicting complicated appendicitis.Methods: In this study, the records of 220 patients who underwent appendectomy with the pre-diagnosis of acute appendicitis in our clinic between January-2020 and August-2021 were retrospectively reviewed. Age, gender, and CRP and TSB levels of the patients were recorded. The patients were divided into two groups according to the postoperative histopathology as acute complicated appendicitis (Group-1) and acute non-complicated appendicitis (Group-2). There were 72 patients in Group-1 and 148 patients in Group-2. Results: TSB levels were high in 75% of patients in group 1 and 19% of patients in group 2. While the CRP level increased in 90% of the patients in the 1st group, it increased in 34% of the 2nd group. While the mean TSB levels were 1.16 ± 0.90 mg/dL in Group-1, they were 0.56 ± 0.35 mg/ dL in Group-2. The mean value of CRP was 77.8 ± 59.5 mg/dL and 22.9 ± 14.20 mg/dL, respectively. CRP and TSB levels were statistically significantly higher in patients with acute complicated appendicitis. Conclusion: Because they are cheap, simple and readily available in almost every laboratory, CRP and TSB can be used as a clinical marker to support the diagnosis in patients with clinically suspected acute complicated appendicitis.

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“…Studies have found that Escherichia coli endotoxin can cause dose-dependent cholestasis, and Escherichia coli can also cause hemolysis of red blood cells, thereby increasing the bilirubin load ( 24 , 25 ). Furthermore, in CA patients, severe inflammation can lead to intestinal edema and hypomotility, which can also lead to cholestasis ( 26 ). Sevinç MM et al found that TBil >1.0 mg/dL was significantly associated with appendix perforation (OR = 2.6) in 3392 patients with acute appendicitis ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Clinical Prediction Model for Complicated Appendicitis in the Elderly

Feng

Wang

et al. 2022

Front. Surg.

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BackgroundFor elderly patients with mild clinical symptoms of uncomplicated appendicitis(UA), non-surgical treatment has been shown to be feasible, whereas emergency surgical treatment is recommended in elderly patients with complicated appendicitis(CA), but it is still challenging to accurately distinguish CA and UA before treatment. This study aimed to develop a predictive model to assist clinicians to quickly determine the type of acute appendicitis.MethodsWe retrospectively studied the clinical data of elderly patients with acute appendicitis who visited the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2012 to January 2022. The patients were divided into UA group and CA group, and the general conditions, medical history, physical examination, laboratory examination and imaging examination were compared between the two groups, and SPSS 26.0 and R 4.0.2 software were used to establish CA clinic. Predict the model, and validate it internally.ResultsThe clinical data of 441 elderly patients with acute appendicitis were collected, 119 patients were excluded due to incomplete clinical data or other diseases. Finally, 332 patients were included in the study and divided into UA group (n = 229) and CA group (n = 103). By analyzing the clinical data of the two groups of patients, the duration of abdominal pain [OR = 1.094, 95% CI (1.056–1.134)], peritonitis [OR = 8.486, 95% CI (2.017–35.703))] and total bilirubin [OR = 1.987, 95% CI (1.627–2.426)] were independent predictors of CA (all p < 0.01). The model's Area Under Curve(AUC) = 0.985 (95% CI, 0.975–0.994). After internal verification by Bootstrap method, the model still has high discriminative ability (AUC = 0.983), and its predicted CA curve is still in good agreement with the actual clinical CA curve.ConclusionWe found that a clinical prediction model based on abdominal pain duration, peritonitis, and total bilirubin can help clinicians quickly and effectively identify UA or CA before treatment of acute appendicitis in the elderly, so as to make more scientific clinical decisions.

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Hyperbilirubinemia as a predictor of severity of acute appendicitis

Cited by 30 publications

References 16 publications

Hyperbilirubinemia and Hyponatremia as Predictors of Complicated Appendicitis

Hyperbilirubinemia and Hyponatremia as Predictors of Complicated Appendicitis

Çocuklarda komplike apandisit tanısında bilirubin ve C-reaktif protein yüksekliğinin değerlendirilmesi

Development and Validation of a Clinical Prediction Model for Complicated Appendicitis in the Elderly

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