Serum bilirubin concentration as a marker of severity of acute appendicitis.

Abstract

Introduction: Acute appendicitis (AA) is one of the most common causes of urgent admission to the hospital. Clinically applicable classification distinguishes simple and complex inflammation. Among commonly used inflammation markers of AA, bilirubin concentration is not well studied and thus is rarely applied. Aim: To examine the association between increased serum total bilirubin concentration and the severity of AA. Material and methods: This retrospective study included 169 patients with a presumptive diagnosis of AA who were operated upon between 2015 and 2017. The determined study endpoints were simple complex inflammation and a different diagnosis after surgery. The Mann-Whitney U, Kruskal-Wallis, Fisher's exact, Spearman correlation coefficient and logistic regression tests and receiver-operating characteristics (ROC) were used in analyses. The area under the curve (AUC) was presented with 95% confidence intervals (95% CIs). Statistical significance was set at 0.05. Results: In total, 84 (49.7%) patients underwent laparotomy and 85 (50.3%) laparoscopy. After surgery, 45 (26.6%) patients had a diagnosis other than AA. Furthermore, 83 (49.1%) and 41 (24.3%) patients had simple and complex AA, respectively. The median bilirubin concentration was 0.56, 0.69, and 1.08 mg/dl in patients without AA, with simple, and complex AA, respectively (p < 0.01). The optimal cutoff for serum bilirubin concentration to predict AA severity was ≥ 0.94 mg/dl (AUC = 0.652; 95% CI: 0.543-0.761) with a 44.9% positive and 83.9% negative predictive value (p = 0.006). Conclusions: The serum bilirubin concentration should be considered as one of the possible markers of AA. Moreover, it can be used to predict the severity of AA.

Establishment of predictive models for acute complicated appendicitis during pregnancy—A retrospective case–control study

“…Although it is challenging to discriminate CA from UCA based on the laboratory tests or imaging examinations, previous research has proposed some factors, including age, 8,13,17,22 sex, 13,17 body temperature, 8,13,23 white blood cell, 8,17,24–26 neutrophil‐to‐lymphocyte ratio, 24,26,27 tuberculosis, 24,28–30 sodium, 18,22,25 and symptom duration, 13,25 that can predict CA. However, these studies did not include pregnant patients 13 or did not analyze pregnant patients separately 17,22,24,26,28,29 …”

Hyperbilirubinemia as a new predictor of appendicular perforation in acute appendicitis.

“…1,2 Any delay or misdiagnosis carries mortality of 0.3% with morbidity of as perforation around 6%. 3 Inflammatory markers and CT scan are helping tools but taking an advantage of CT Pelvis in adult females is still a controversy. 3 Serum bilirubin, (a tetrapyrrole,) is produced as a result of degradation of various haemo-proteins like haem part of haemoglobin and myoglobin.…”

“…3 Inflammatory markers and CT scan are helping tools but taking an advantage of CT Pelvis in adult females is still a controversy. 3 Serum bilirubin, (a tetrapyrrole,) is produced as a result of degradation of various haemo-proteins like haem part of haemoglobin and myoglobin. 4 This accumulation of bilirubin due to increased production or decreased clearance in patients with acute appendicitis or perforated appendices might play an important role in early diagnosis of this condition and would ultimately help in reducing mortality and morbidity associated with it.…”