Hyperbilirubinaemia: its utility in non-perforated appendicitis

Area of Science:

• Medical diagnostics
• Biochemistry
• Surgical pathology

Background:

• Acute appendicitis diagnosis relies on clinical findings and investigations.
• Serum bilirubin is a cost-effective biochemical marker with potential for diagnosing appendiceal perforation.
• Previous studies suggest serum bilirubin may be more specific than C-reactive protein (CRP) and white cell count (WCC).

Purpose of the Study:

• To evaluate the diagnostic utility of serum bilirubin levels in patients with suspected acute, non-perforative appendicitis.
• To compare the effectiveness of serum bilirubin against CRP and WCC in appendicitis diagnosis.
• To determine the specificity and positive predictive value (PPV) of serum bilirubin.

Main Methods:

• Retrospective chart review of 213 patients with suspected appendicitis.
• Recorded and analyzed serum bilirubin, WCC, and CRP levels in relation to final diagnosis.
• Included patients who underwent appendicectomy, with analysis of both negative and positive findings.

Main Results:

• Serum bilirubin demonstrated an overall specificity of 0.83 and PPV of 0.86, outperforming CRP and WCC in specificity.
• For complicated appendicitis, bilirubin's PPV was 0.66, compared to WCC (0.58) and CRP (0.34).
• Hyperbilirubinaemia showed a high PPV of 0.81 in simple appendicitis, compared to CRP (0.71) and WCC (0.82).

Conclusions:

• Serum bilirubin offers superior specificity compared to CRP and WCC for diagnosing appendicitis.
• Hyperbilirubinaemia is a valuable indicator with a high positive predictive value in cases of simple appendicitis.
• The findings support the use of serum bilirubin as a useful diagnostic tool in appendicitis.