Bilirubin is a specific marker for the diagnosis of acute appendicitis

Zosimas,Dimitrios; Lykoudis,Panagis M.; Strano,Giuseppe; Burke,Josh; Al‑Cerhan,Eyad; Shatkar,Veeranna

doi:10.3892/etm.2021.10490

Bilirubin is a specific marker for the diagnosis of acute appendicitis

Authors:
- Dimitrios Zosimas
- Panagis M. Lykoudis
- Giuseppe Strano
- Josh Burke
- Eyad Al‑Cerhan
- Veeranna Shatkar
View Affiliations

Affiliations: Department of General Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK, Division of Surgery and Interventional Science, University College London, London WC1E 6BT, UK
Published online on: July 23, 2021 https://doi.org/10.3892/etm.2021.10490
Article Number: 1056

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Total serum bilirubin and other biochemical parameters have been associated with acute appendicitis, mainly in complicated cases. The present study aimed to evaluate the role of biochemical parameters in the diagnosis of acute appendicitis, and to further investigate the role of bilirubin as a diagnostic marker irrespective of the severity of the pathology. All recorded cases of appendicectomies in a 1‑year period in a single institution were reviewed. The median values of white cell count, C‑reactive protein and total serum bilirubin on admission were associated with final histology, and their respective rates of abnormal and normal values were compared between patients who were proven to have negative histology and patients who were proven to have acute appendicitis. A total of 300 patients were studied. Median total serum bilirubin, white cell count and C‑reactive protein on admission were significantly associated with acute appendicitis (P<0.001). Respective rates of normal and abnormal values were significantly associated with final histology (P<0.001). Total serum bilirubin demonstrated higher specificity (0.88) but lower sensitivity (0.26) and diagnostic accuracy (0.40) for acute appendicitis. In conclusion, total serum bilirubin on admission should be considered in the diagnostic workup to confirm rather than exclude appendicitis, without focusing on subgroups of specific severity of the disease. White cell count and C‑reactive protein may also contribute to the diagnostic work‑up, although with limited accuracy.

View Figures

View References

1	Slotboom T, Hamminga JT, Hofker HS, Heineman E and Haveman JW: Apple Study Group A and Laparoscopic Evaluation. Intraoperative motive for performing a laparoscopic appendectomy on a postoperative histological proven normal appendix. Scand J Surg. 103:245–248. 2014.PubMed/NCBI View Article : Google Scholar
2	Adams HL and Jaunoo SS: Hyperbilirubinaemia in appendicitis: The diagnostic value for prediction of appendicitis and appendiceal perforation. Eur J Trauma Emerg Surg. 42:249–252. 2016.PubMed/NCBI View Article : Google Scholar
3	Al-Abed YA, Alobaid N and Myint F: Diagnostic markers in acute appendicitis. Am J Surg. 209:1043–1047. 2015.PubMed/NCBI View Article : Google Scholar
4	Sack U, Biereder B, Elouahidi T, Bauer K, Keller T and Trobs RB: Diagnostic value of blood inflammatory markers for detection of acute appendicitis in children. BMC Surg. 6(15)2006.PubMed/NCBI View Article : Google Scholar
5	Eryigit V, Mahsanlar Y, Demirtas Y and Parlak I: The value of ultrasonography, leukocyte count and clinical results in diagnosis of acute appendicitis and the duration of stay of the patients in emergency department. Turk J Emerg Med. 14:20–24. 2014.PubMed/NCBI View Article : Google Scholar
6	D'Souza N, D'Souza C, Grant D, Royston E and Farouk M: The value of ultrasonography in the diagnosis of appendicitis. Int J Surg. 13:165–169. 2015.PubMed/NCBI View Article : Google Scholar
7	Emmanuel A, Murchan P, Wilson I and Balfe P: The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. Ann R Coll Surg Engl. 93:213–217. 2011.PubMed/NCBI View Article : Google Scholar
8	Ramasamy Ramu T, Chinnakkulam Kandhasamy S, Andappan A and Sankar TB: A prospective study on the diagnostic value of hyperbilirubinemia as a predictive factor for appendicular perforation in acute appendicitis. Cureus. 10(e3214)2018.PubMed/NCBI View Article : Google Scholar
9	Bonadio W, Bruno S, Attaway D, Dharmar L, Tam D and Homel P: Lack of utility of measuring serum bilirubin concentration in distinguishing perforation status of pediatric appendicitis. Am J Emerg Med. 35:885–888. 2017.PubMed/NCBI View Article : Google Scholar
10	Silva FR, da Rosa MI, Silva BR, Simon C, Alexandre MC, Medeiros LR, Bitencourt FS and dos Reis ME: Hyperbilirubinaemia alone cannot distinguish a perforation in acute appendicitis. ANZ J Surg. 86:255–259. 2016.PubMed/NCBI View Article : Google Scholar
11	Sandstrom A and Grieve DA: Hyperbilirubinaemia: Its utility in non-perforated appendicitis. ANZ J Surg. 87:587–590. 2017.PubMed/NCBI View Article : Google Scholar
12	Miller DF and Irvine RW: Jaundice in acute appendicitis. Lancet. 1:321–323. 1969.PubMed/NCBI View Article : Google Scholar
13	Chaudhary P, Kumar A, Saxena N and Biswal UC: Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: A prospective study. Ann Gastroenterol. 26:325–331. 2013.PubMed/NCBI
14	Sand M, Bechara FG, Holland-Letz T, Sand D, Mehnert G and Mann B: Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg. 198:193–198. 2009.PubMed/NCBI View Article : Google Scholar
15	Panagiotopoulou IG, Parashar D, Lin R, Antonowicz S, Wells AD, Bajwa FM and Krijgsman B: The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications. Ann R Coll Surg Engl. 95:215–221. 2013.PubMed/NCBI View Article : Google Scholar
16	Muller S, Falch C, Axt S, Wilhelm P, Hein D, Konigsrainer A and Kirschniak A: Diagnostic accuracy of hyperbilirubinaemia in anticipating appendicitis and its severity. Emerg Med J. 32:698–702. 2015.PubMed/NCBI View Article : Google Scholar
17	Khan S: The Diagnostic value of hyperbilirubinemia and total leucocyte count in the evaluation of acute appendicitis. J Clin Diagn Res. 3:1647–1652. 2009.
18	Sevinc MM, Kinaci E, Cakar E, Bayrak S, Ozakay A, Aren A and Sari S: Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: An analysis of 3392 cases. Ulus Travma Acil Cerrahi Derg. 22:155–162. 2016.PubMed/NCBI View Article : Google Scholar
19	Farooqui W, Pommergaard HC, Burcharth J and Eriksen JR: The diagnostic value of a panel of serological markers in acute appendicitis. Scand J Surg. 104:72–78. 2015.PubMed/NCBI View Article : Google Scholar
20	D'Souza N, Karim D and Sunthareswaran R: Bilirubin; a diagnostic marker for appendicitis. Int J Surg. 11:1114–1117. 2013.PubMed/NCBI View Article : Google Scholar
21	Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, Nyhsen C and Owens CM: How to diagnose acute appendicitis: Ultrasound first. Insights Imaging. 7:255–263. 2016.PubMed/NCBI View Article : Google Scholar
22	Kamran H, Naveed D, Asad S, Hameed M and Khan U: Evaluation of modified Alvarado score for frequency of negative appendicectomies. J Ayub Med Coll Abbottabad. 22:46–49. 2010.PubMed/NCBI
23	Markar SR, Karthikesalingam A, Falzon A and Kan Y: The diagnostic value of neutrophil: Lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg. 110:543–547. 2010.PubMed/NCBI
24	Yokoyama S, Takifuji K, Hotta T, Matsuda K, Nasu T, Nakamori M, Hirabayashi N, Kinoshita H and Yamaue H: C-Reactive protein is an independent surgical indication marker for appendicitis: A retrospective study. World J Emerg Surg. 4(36)2009.PubMed/NCBI View Article : Google Scholar
25	Sengupta A, Bax G and Paterson-Brown S: White cell count and C-reactive protein measurement in patients with possible appendicitis. Ann R Coll Surg Engl. 91:113–115. 2009.PubMed/NCBI View Article : Google Scholar
26	Chung JL, Kong MS, Lin SL, Lin TY, Huang CS, Lou CC and Lin JN: Diagnostic value of C-reactive protein in children with perforated appendicitis. Eur J Pediatr. 155:529–531. 1996.PubMed/NCBI View Article : Google Scholar
27	Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY and Lee CC: Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg. 100:322–329. 2013.PubMed/NCBI View Article : Google Scholar
28	Shindoh J, Niwa H, Kawai K, Ohata K, Ishihara Y, Takabayashi N, Kobayashi R and Hiramatsu T: Diagnostic power of inflammatory markers in predicting severity of appendicitis. Hepatogastroenterology. 58:2003–2006. 2011.PubMed/NCBI View Article : Google Scholar