Diagnostic value of serum bilirubin in appendicular perforation

Abstract

Background: Hyperbilirubinemia has been well documented in relation to acute appendicitis. This study tries to establish the diagnostic value of this parameter in determining the severity of acute appendicitis.Methods: This is a prospective analytical study conducted on 100 patients with acute appendicitis. All patients were subjected to clinical evaluation and investigations; including liver function tests. The diagnosis was confirmed peri-operatively and postoperatively by histopathological examination. The data was compiled and analysed.Results: The incidence of complicated appendicitis was found to be 18%, defined as evidence of gangrene, or microscopic or gross perforation on histopathological examination. Among these total serum bilirubin (TSB) was raised in 17 cases (17%) and statistically significant correlation was established by p-value <0.001. The mean of TSB level was higher in perforated appendicitis than in cases of acute appendicitis (0.57±0.26 mg/dL; range 0.1-1.2 versus 1.68±1.09 mg/dL; range 0.8-4.8 mg/dL). TSB was shown to have specificity of 96.4%, sensitivity 88.2%, PPV 83.3% and NPV was 97.6%. The diagnostic accuracy of raised bilirubin for diagnosis of appendicular perforation was calculated to be 95.0%. The rise in bilirubin was mixed in type (both indirect and direct). There could not be established any correlation between the liver enzymes and appendicitis or its complications.Conclusions: This study ascertains the predictive value of serum bilirubin in acute appendicitis patients as an indicator of severity. Raised bilirubin in the setting of acute appendicitis identifies higher probability of appendicular perforation.