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Hyperbilirubinemia as a Marker for Complicated Acute Appendicitis: A Systematic Review
Alicja Czyszczon1, Bartosz Maczkowski2, Aneta Tkaczyk3
1Pediatrics, John Paul II Podhale Specialist Hospital, Nowy Targ, POL.
Cureus
|October 27, 2025
Summary
Elevated total bilirubin levels correlate with complicated acute appendicitis (AA), particularly perforation. This biomarker shows higher specificity than traditional markers, aiding in diagnosis when used with clinical assessment and imaging.
Area of Science:
- Surgical Pathology
- Biomarker Discovery
- Gastrointestinal Medicine
Background:
- Acute appendicitis (AA) is a common surgical emergency.
- Early identification of complicated AA (perforation, gangrene) is vital for patient outcomes.
- Total bilirubin is emerging as a potential severity biomarker.
Purpose of the Study:
- To systematically review the diagnostic utility of total bilirubin in identifying complicated AA.
- To assess bilirubin's effectiveness in differentiating uncomplicated from complicated appendicitis.
- To emphasize its role in detecting perforation.
Main Methods:
- Systematic literature search of PubMed, ScienceDirect, and Google Scholar.
- Inclusion of studies investigating the relationship between bilirubin levels and AA severity.
- Analysis of diagnostic specificity compared to inflammatory markers.
Main Results:
- A correlation exists between hyperbilirubinemia and perforated appendicitis.
- Bilirubin demonstrates higher diagnostic specificity than leukocytosis or CRP.
- Elevated bilirubin is linked to an increased risk of complicated AA.
Conclusions:
- Hyperbilirubinemia is associated with complicated AA, especially perforation.
- Bilirubin offers superior specificity to classical inflammatory markers.
- Bilirubin serves as a supportive diagnostic parameter, not a standalone test, when combined with clinical and imaging data.
Keywords:
acute appendicitisbilirubin concentrationdiagnostic biomarkerhyperbilirubinemiaperforated appendicitisMore Related Videos
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