A study on the diagnostic value of hyperfibrinogenemia as a predicting factor for appendicular perforation in acute appendicitis

ABSTRACT Introduction: Acute appendicitis (AA) is one of the most prevalent causes of urgent abdominal surgery where timely diagnosis remains a challenge. Early intervention may lead to negative appendectomy and delay may lead to perforated appendicitis. Materials and Methods: A cross-sectional study was conducted on 72 patients presenting with features of AA from January 2021 to October 2022 in the Department of Surgery, Regional Institute Of Medical Sciences Hospital, Imphal, Manipur, India. Blood for serum fibrinogen was collected in all patients preoperatively. Results: Out of 72 patients, males were 52.8%. The majority of the patients were in the age group 20–30 years (33.3%), and the mean age was 29.83 ± 15.89 years. All the patients had pain in the right lower quadrant of the abdomen, tenderness at the right iliac fossa, and rebound tenderness. However, migratory right iliac fossa pain was present in only 51.4% of patients. Fever (70.8%), anorexia (86.1%), nausea (59.7%), and vomiting (41.7%) were also seen among the patients. Increased serum fibrinogen level (>400 mg/dL) and high total leucocyte count (>11,000/µL) were seen to be significantly associated with complicated appendicitis. The area under the curve was 0.925 that is, it has an accuracy of around 90% and this was statistically significant ( P < 0.001). Taking a cut-off level of serum fibrinogen at 450.4, then it gives a sensitivity of 85.71% and specificity of 95.45%. Conclusion: Serum fibrinogen seems to be a useful marker for distinguishing between complicated appendicitis and uncomplicated AA, and the level of 450.4 mg/dL is the best serum fibrinogen value to predict complicated AA.