Evaluation of hyperbilirubinemia as an innovative diagnostic marker for acute appendicitis and its role in the prediction of appendicular perforation

Abstract

Background: Acute appendicitis is one of the most common causes of acute abdomen in surgical practice. Despite advances in the radiological and laboratory investigations, the diagnosis of appendicitis remains dilemma. The negative appendicectomy rate varies 15-50%, with up to 50% postoperative complications in these patients. Hence we conducted a study to assess the role of hyperbilirubinemia in diagnosing acute appendicitis and to foresee appendicular perforation.Methods: It was a prospective study conducted in the Department of General Surgery, M.R. Medical College, Gulbarga, Karnataka, India for 18 months duration from December 2010 to May 2012. Only histopathologically confirmed cases of acute appendicitis and/or appendicular perforation were included in the study. Demographic data, history and clinical findings were recorded on a predesigned proforma. Investigations included complete blood count, reticulocyte count, platelet count, peripheral smear, serum haptoglobulin, liver function tests, HbsAg, urine analysis (routine and microscopy).Results: The sensitivity and specificity of serum bilirubin as a marker in predicting acute appendicitis and appendicular perforation was 78.6% and 8.6% respectively. Similarly, the positive predictive value and negative predictive value for the same was 77.5% and 9.1% respectively. The Odds ratio was 0.344.Conclusions: Serum bilirubin level appears to be a promising new laboratory marker for diagnosing acute appendicitis and would be a decision-making investigation. Patients with clinical appendicitis and with hyperbilirubinemia are to be suspected of having a higher risk for appendicular perforation.