Role of serum bilirubin as a marker of acute gangrenous appendicitis

Abstract

Background: This study has compared the difference in serum bilirubin between patients with gangrenous and non-gangrenous appendicitis. Methods: A prospective analytical study of, 141 patients who underwent appendectomy, from March 2010 to March 2011 in Manipal Teaching Hospital, Pokhara, Nepal was carried out. Clinico-demographic data, Alvarado’s score, total serum bilirubin, total leucocyte count and histopathological report of all the cases were collected in a prestructured proforma. Comparison between gangrenous and non-gangrenous appendicitis groups was carried out using independent sample t test, Chisquare test, and direct logistic regression. The data was analyzed using SPSS 11.6 software. Result: Around 43% (61 out of 141) patients had gangrenous appendicitis and statistically significant difference was found between the two groups in total Alvarado’s score, total count and total bilirubin level. The effect size as indicated by eta square statistics was large for total bilirubin (eta squared=0.39) as compared to total Alvarado’s score (0.09) and total leucocyte count (0.05). Direct logistic regression model showed serum total bilirubin as the only independent variable to make a unique statistically significant contribution in predicting gangrenous appendicitis. Conclusion: Pre-operative assessment of serum total bilirubin can serve as an important maker of acute gangrenous appendicitis. DOI: http://dx.doi.org/10.3126/njms.v1i2.6606 Nepal Journal of Medical Sciences. 2012;1(2): 89-92

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“…This in contrast to Ghimire et al, (2012) who found a statistically significant different rise in TSB level in gangrenous appendicitis.…”

Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation

“…Conclusion Bilirubin levels may be high, but remain within normal range, in cases of appendicitis. Therefore, bilirubin levels may be a useful measurement when Increased levels of bacteria enter the portal venous system and invade the hepatic parenchyma which interferes with the excretion of bilirubin resulting in hyperbilirubinaemia [13][14][15] and raised inflammatory markers [16].…”

Hyperbilirubinemia as a diagnostic marker for acute appendicitis

“…22 The study done Hong et al reported that the univariate analysis demonstrated significant differences for TLC (p<0.0001), total bilirubin (p<0.0001) and Alvarado score (p<0.0001). The multivariate analysis demonstrated that…”

“…21 Another study Ghimire P et al has stated that 57.7% patients with hyperbilirubinemia had gangrenous or perforated appendix. 22 The study done by Khan S et al there was hyperbilirubinemia in 86.6% of the patient of acute appendicitis bilirubin ranged from 1.2mg/dl-8.4mg/dl. 4 So Authors observed that bilirubin can be important investigation for diagnosing the Appendicular infection.…”