Hyperbilirubinemia and acute appendicitis: a cohort study

BACKGROUND: Appendicitis is a common emergency surgical condition that has relatively high mortality and morbidity rates in complicated cases. The risk of misdiagnosis and timing of surgery are often problems. The use of diagnostic scoring and laboratory and radiological investigations has not been able to eliminate these issues. Bilirubin is a new marker that has been widely studied for its ability to diagnose and differentiate the severity of appendicitis. The aim of this study was to identify the effects and potential of using patient serum bilirubin as a marker of the severity of acute appendicitis.METHODS: This observational analytic study had a prospective cohort design. The study population comprised appendicitis patients from the emergency department. Pre-operative examinations assessed leukocytes, neutrophils, C-reactive protein (CRP), and bilirubin.RESULTS: Most patients were aged ≤30 years (57.5%) with the most common gender being male (57.5%). The Alvarado and Labeda diagnostic scores were mostly in the very probable (60%) and definite (77.5%) categories. The most common histopathological result was perforated appendicitis (35%). We found a difference in the mean levels of CRP and direct, indirect, and total bilirubin, which were higher in the acute appendicitis group, and this result was statistically significant (P=0.03; P<0.001; P<0.001; and P<0.001). However, we found a significant relationship only between indirect bilirubin and the severity of acute appendicitis (P=0.01) with a sensitivity of 100%, a specificity of 33.33%, a positive predictive value of 57.78%, a negative predictive value of 100%, and an area under the curve (AUC) of 0.788.CONCLUSIONS: Bilirubin has the potential to be a marker in predicting the severity of acute appendicitis; however, this inflammatory biomarker cannot be used as a single predictor. The timing of surgery cannot be determined solely by the assessment of inflammatory biomarkers.