Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study

Abstract

Purpose To compare the performance for the prediction of perforated appendicitis of total bilirubin versus C-reactive protein (CRP), white blood cell count, the time period of symptoms' evolution, and systemic infl ammatory response syndrome (SIRS).Methods Prospective observational study, applying receiver operating characteristics curve analysis to compare the sensitivity and specifi city of the tested variables. ResultsThe period of symptom's evolution was prolonged (105.2 ± 79.3 hours vs. 38.6 ± 17.5 hours), and CRP levels were higher in perforated appendicitis (176 ± 82.6 mg/l vs. 80 ± 76 mg/l). Most patients with perforated appendicitis had a SIRS score higher than 3 points. CRP (>76.7 mg/l), the time period of symptoms' evolution (>34.5 hours), and SIRS (3 points or more), were the best cutoff values to predict perforated appendicitis.Conclusions Perforated appendicitis may be suspected based on CRP, SIRS and the time period of symptoms' evolution. We do not recommend the use of total bilirubin to predict perforation in appendicitis.

The Systemic Inflammatory Response in Patients with Appendicitis: a Progressive Phenomenon

“…SIRS criteria were defined as temperature higher than 38°C or lower than 36°C, heart rate (HR) higher than 90/min, respiratory rate (RR) higher than 20/min, and WBC higher than 12,000/mm 3 or lower than 4,000/mm 3 ; one point was assigned for every positive parameter which yielded a score from zero to four points [5,9]. A patient was considered to have SIRS when two or more points were simultaneously present [9 ].…”

“…The inflammatory response to acute life-threatening conditions including appendicitis has been a subject of intensive study [1][2][3][4][5][6][7][8]. The regional and systemic responses have been described [2,4], inflammatory parameters have been applied to diagnostic algorithms [3][4][5][6], and diagnostic scores incorporating inflammatory parameters have been developed [7,8].…”

“…The regional and systemic responses have been described [2,4], inflammatory parameters have been applied to diagnostic algorithms [3][4][5][6], and diagnostic scores incorporating inflammatory parameters have been developed [7,8]. The systemic inflammatory response syndrome (SIRS) reflects the human inflammatory response to injury and infection [9].…”

“…Although the presence of SIRS has been described in patients with appendicitis, its progressive response associated with progression of clinical symptomatology has not been described and characterized. Continued systemic inflammation in patients with injury and infectious processes may result in multiple organ dysfunction and failure [1,2,5]. As with any acute inflammatory condition, the patients' systemic inflammatory response to appendicitis will progress, becoming more pronounced.…”

Letter to the Editor regarding Adams HL, Jaunoo SS. Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation. Eur J Trauma Emerg Surg. 2016; 42:249–52

“…We wonder if those results changed the clinical decision and evaluation pathways in the authors' hospital, especially in light of already published papers covering this topic [2]. Two prospective trials, carried out and published prior to their paper, resulted in an even more devastating verdict over this parameter, concluding it to be of limited value in clinical routine and not to be recommended to predict perforation in appendicitis [3,4].…”