Role of platelet indices as a biomarker for the diagnosis of acute appendicitis and as a predictor of complicated appendicitis: A meta-analysis

Luminal obstruction has been widely considered as one of the major causes of appendicitis. Faecolith, in this case called appendicolith, is a hardened lump of faeces in varying sizes, have over the years been closely associated with appendicitis as a potential cause of luminal obstruction. There are varying opinions with regards to role of appendicolith in both uncomplicated and complicated acute appendicitis. While some authors have reported that the presence of appendicolith is a predictive factor for high failure rates, others are of the opinion that appendicolith does not necessarily predict non-operative treatment failure, and even if so, not as an independent factor. Opinions also seem to be divided on the correlation between complicated appendicitis and the presence of appendicolith. This chapter seeks to discuss the evidence available and attempt to clarify the controversies surrounding the role of appendicolith in acute appendicitis using current evidence available.

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Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

10.21203/rs.2.21496/v6 ◽

2021 ◽

Author(s):

Sabyasachi Bakshi ◽

Nilay Mandal

Keyword(s):

Acute Appendicitis ◽

Likelihood Ratio ◽

Bilirubin Level ◽

Predictive Value ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Total Bilirubin Level ◽

Complicated Appendicitis ◽

Total Serum

Abstract BACKGROUND:In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied.METHODS:After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination.RESULTS:Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was Mixed Type Of Hyperbilirubinemia in gangrenous/perforated appendicitis.The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively.Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of Complicated appendicitis be 31.80%.ROC (Receiver Operating Characteristic) curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence.CONCLUSIONS:This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications.Trial Registration: Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019.This was a prospective trial. Trial URL:http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27

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Evaluation of role of hyperbilirubinemia as a new diagnostic marker of complicated appendicitis

BMC Gastroenterology ◽

10.1186/s12876-021-01614-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sabyasachi Bakshi ◽

Nilay Mandal

Keyword(s):

Acute Appendicitis ◽

Likelihood Ratio ◽

Bilirubin Level ◽

Predictive Value ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Perforated Appendicitis ◽

Total Bilirubin Level ◽

Complicated Appendicitis

Abstract Background In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi. In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. Methods After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. Results Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03 (8.58%) had normal levels. Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels. It was Mixed Type of Hyperbilirubinemia in gangrenous/perforated appendicitis. The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively. Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of complicated appendicitis be 31.80%. Receiver Operating Characteristic curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. Conclusions This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial registration Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. This was a prospective trial. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27.

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The Diagnostic Role of Hyperbilirubinemia in Complicated and Non -complicated Appendicitis.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v2i2.14 ◽

2018 ◽

Vol 2 (2) ◽

Author(s):

Valon Zejnullahu ◽

Rozalinda Isjanovska ◽

Besnik Bicaj ◽

Vjosa A. Zejnullahu ◽

Astrit R. Hamza ◽

...

Keyword(s):

Acute Appendicitis ◽

Clinical Signs ◽

Cross Sectional Study ◽

Complicated Appendicitis ◽

Clinical Approach ◽

Cross Sectional ◽

Laboratory Marker ◽

Diagnostic Role ◽

Sensitivity Specificity

Background: Acute appendicitis is one of the most frequent causes of abdominal pain. Early diagnosis is the key to success for the surgeon, followed by the treatment with operation or conservative treatment as a new approach, before the stage of gangrenous appendicitis or perforation occurs.Aim: This study aims to establish he role of hyperbilirubinemia as a laboratory marker in prediction of acute appendicitis in the early diagnosis.Materials and methods: This is a cross-sectional study; it included 201 patients admitted in the emergency ward with suspicion for acute appendicitis. All patients that participated in this study have been subject to appendectomy. The blood samples were taken from all patients in order to analyze the level of total/direct bilirubin.Results: The study samples of 201 patients consisted of 67.7% with complicated appendicitis and 32.3% with non-complicated appendicitis. The sensitivity, specificity, PPV, NPV for laboratory marker, as predictor for complicated vs non-complicated cases of appendicitis was as follows: Total bilirubin; specificity (72.3%), sensitivity (54.4%), PPV (80.4%), NPV (43.1%),Conclusion: Elevation of total/direct bilirubin level in patients with clinical signs of acute appendicitis might predict the stage of acute appendicitis, such prediction may help surgeons to provide accurate treatment of the disease without delay in the diagnosis. This accuracy can be further supplemented by using Alvarado scoring model during the clinical approach.

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Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

10.21203/rs.2.21496/v5 ◽

2020 ◽

Author(s):

Sabyasachi Bakshi ◽

Nilay Mandal

Keyword(s):

Acute Appendicitis ◽

Likelihood Ratio ◽

Bilirubin Level ◽

Predictive Value ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Total Bilirubin Level ◽

Complicated Appendicitis ◽

Total Serum

Abstract BACKGROUND:In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied.METHODS:After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination.RESULTS:Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was Mixed Type Of Hyperbilirubinemia in gangrenous/perforated appendicitis.The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively.Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of Complicated appendicitis be 31.80%.ROC (Receiver Operating Characteristic) curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence.CONCLUSIONS:This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications.Trial Registration: Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27

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Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

10.21203/rs.2.21496/v4 ◽

2020 ◽

Author(s):

Sabyasachi Bakshi ◽

Nilay Mandal

Keyword(s):

Acute Appendicitis ◽

Likelihood Ratio ◽

Bilirubin Level ◽

Predictive Value ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Perforated Appendicitis ◽

Total Bilirubin Level ◽

Complicated Appendicitis

Abstract BACKGROUND: In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. METHODS: After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. RESULTS: Out of 110 subjects with acute appendicitis, 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects, diagnosed as complicated appendicitis, 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was MIXED TYPE OF HYPERBILIRUBINEMIA in gangrenous/perforated appendicitis. The SENSITIVITY of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the SPECIFICITY of this test was 88.00% (78.439% to 94.363%). POSITIVE PREDICTIVE VALUE and NEGATIVE PREDICTIVE VALUE were 78.03% and 95.65% respectively. POSITIVE LIKELIHOOD RATIO and NEGATIVE LIKELIHOOD RATIO were found to be 7.619 and 0.097 respectively taking PREVALENCE of Complicated appendicitis be 31.80%. ROC (Receiver Operating Characteristic) curve was obtained which shows OPTIMAL CRITERION at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. CONCLUSIONS: Serum Bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial Registration:Trial URL: http://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=33113&EncHid=2976.35990&modid=1&compid=19

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Correction to: Platelet indices in patients with acute appendicitis: a systematic review with meta‑analysis

Updates in Surgery ◽

10.1007/s13304-021-01003-9 ◽

2021 ◽

Author(s):

Guixin Shen ◽

Senjuan Li ◽

Zhuo Shao ◽

Lianjie Liu ◽

Qizhi Liu ◽

...

Keyword(s):

Systematic Review ◽

Acute Appendicitis ◽

Meta Analysis ◽

Platelet Indices

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Role of leucocytosis, hyperbilirubineamia, decreased mean platelet volume and increased international normalized ratio in prediction of complicated appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20212275 ◽

2021 ◽

Vol 8 (6) ◽

pp. 1804

Author(s):

Amit Soni ◽

Dharmendra K. Pipal ◽

Anupam Bhargava ◽

Saurabh Jain ◽

Yatindra Singh ◽

...

Keyword(s):

Acute Appendicitis ◽

Mean Platelet Volume ◽

Leucocyte Count ◽

Serum Bilirubin ◽

International Normalized Ratio ◽

Complicated Appendicitis ◽

Total Leucocyte Count ◽

Platelet Volume ◽

Laboratory Markers

Background: A diagnostic approach for complicated appendicitis is still controversial. We analyzed the preoperative laboratory markers that may predict complicated appendicitis.Methods: To study the role of leukocytosis, hyperbilirubinemia, decreased mean platelet volume (MPV) and increased international normalized ratio (INR) in the prediction of complicated appendicitis. Total 60 patients were enrolled and divided them into 2 groups, un-complicated (AUA) and complicated (ACA) acute appendicitis, each having 30 cases.Results: Total leucocyte count (TLC) >10000 mm³ was found in 70% of AUA cases and 80% of ACA cases serum bilirubin >1 mg/dl was found in 66.67% of AUA cases and 80 % of ACA cases. MPV<7.6 fL was found in 60% of AUA and 80% of ACA cases INR >1.2 was found in 20 % of AUA and 40% of ACA cases. TLC >10000/mm³, serum bilirubin >1 mg/dl and MPV <7.6 fL was found in 46.67% of AUA cases and 70 % of ACA cases.Conclusions: Total leucocyte count, serum bilirubin and mean platelet volume have a predictive potential for the diagnosis of complicated appendicitis.

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Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

10.21203/rs.2.21496/v3 ◽

2020 ◽

Author(s):

Sabyasachi Bakshi ◽

Nilay Mandal

Keyword(s):

Acute Appendicitis ◽

Likelihood Ratio ◽

Bilirubin Level ◽

Predictive Value ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Total Bilirubin Level ◽

Complicated Appendicitis ◽

Total Serum

Abstract BACKGROUND:In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied.METHODS:After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination.RESULTS:Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was Mixed Type Of Hyperbilirubinemia in gangrenous/perforated appendicitis.The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively.Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of Complicated appendicitis be 31.80%.ROC (Receiver Operating Characteristic) curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence.CONCLUSIONS:This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial Registration: Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27

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Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

10.21203/rs.2.21496/v1 ◽

2020 ◽

Author(s):

Sabyasachi Bakshi ◽

Nilay Mandal

Keyword(s):

Acute Appendicitis ◽

Bilirubin Level ◽

Predictive Value ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Perforated Appendicitis ◽

Total Bilirubin Level ◽

Complicated Appendicitis ◽

Direct Invasion

Abstract BACKGROUND: Hyperbilirubinemia has also been found in infective diseases involving organs other than liver. The bacteremia/endotoxemia resulting in impaired hepatocyte function and bile secretion along with increased acute phase reactants contribute to the pathogenesis. In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene/perforation. This is accompanied by bacterial cytotoxin facilitated progressive bacterial invasion. This elevated load of bacteria causes direct invasion or translocation into the portal system. Direct invasion of bacteria into the hepatic parenchyma interferes with the bilirubin excretion into the bile canaliculi biochemically rather than by any obstructive pathway. In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. METHODS: After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. RESULTS: Out of 110 patients of acute appendicitis 41 patients (37.27%) had hyperbilirubinemia. Out of 35 patients diagnosed as complicated appendicitis 32 patients (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 patients diagnosed as acute simple appendicitis 09 patients (12%) had raised total bilirubin level, while the remaining 66 patients (88%) had normal levels .It was MIXED TYPE OF HYPERBILIRUBINEMIA in gangrenous/perforated appendicitis. The SENSITIVITY of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the SPECIFICITY of this test was 88.00% (78.439% to 94.363%). POSITIVE PREDICTIVE VALUE and NEGATIVE PREDICTIVE VALUE were 78.03% and 95.65% respectively. POSITIVE LIKELIHOOD RATIO and NEGATIVE LIKELIHOOD RATIO were found to be 7.619 and 0.097 respectively taking PREVALENCE of Complicated appendicitis be 31.80%. ROC (Receiver Operating Characteristic) curve was obtained which shows OPTIMAL CRITERION at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. CONCLUSIONS: Serum Bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial Registration:Trial URL: http://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=33113&EncHid=2976.35990&modid=1&compid=19

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