Evaluation of Hyperbilirubinemia As A Diagnostic Marker for Acute Appendicitis

Abstract

Background and Objectives: Acute Appendicitis is the commonest general surgical emergency, which needs early surgical intervention, to improve the outcome. The rate of misdiagnosis of appendicitis and the rate of appendicular perforation has remained constant, inspite of increased use of ultrasonography, computed tomography scanning and laparoscopy. For early and accurate preoperative diagnosis, acute appendicitis still remains an enigmatic challenge and is a reminder for the art of surgical diagnosis. Our study was done to find if the Serum Bilirubin could be considered as a new laboratory marker to aid in the diagnosis of Acute appendicitis and if so, does it have the predictive capacity to warn us about Appendicular perforation. Materials & Methods: Patients reported to R L Jalappa Hospital and Research centre constituent, of Sri DevrajUrs Medical college, surgery department with acute abdomen, was considered for our study. The Study group included 100 patients. Maximum in the age group of 21-40 years.Clinically proven cases of acute appendicitis and perforation was considered. All the cases were evaluated biochemically to find if any association of serum bilirubin existed/present with clinically proven acute appendicitis. Results: In our study, males were (51%) and females (49%) with overall mean age was 25.41 ± 11.44 years. Of the 100 patients, on HPR 82% were confirmed as acute appendicitis while 11% were diagnosed with Appendicular perforation and 7% were diagnosed as recurrent appendicitis. Of 82 patients with acute appendicitis, 69.5% had elevated bilirubin levels, while 30.5% had normal levels. 11 patients were diagnosed as Appendicular perforation, all patients had elevated bilirubin levels. Of 7 patient with recurrent appendicitis 28.6% patient had elevated bilirubin levels, while 71.4% had normal levels. The Sensitivity and Specificity of serum bilirubin as a marker in predicting Acute appendicitis was 69.51% and 27.78 % respectively. Similarly the Positive predictive value and Negative predictive value was 81.43 % and 16.67% respectively with diagnostic accuracy was 62%. ROC curve showing area under curve for acute appendicitis was 0.26 , and it was highest for appendicular perforation 0.98 with cut off bilirubin 1.85 mg/dl had 100% sensitivity and 92% specificity in diagnosis of appendicular perforation. Conclusion: Serum bilirubin levels comes out to be a favorable laboratory marker for diagnosing acute appendicitis, however diagnosis of appendicitis remains static-clinical. Its level appears to be a useful marker in diagnosis of appendicitis and would be helpful in managing acute cases. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia more than the normal range should be considered as having a higher chance of Appendicular perforation suggesting, serum bilirubin levels have a promising predictive potential for the early diagnosis of Appendicular perforation.