Diagnostic value of serum hyperbilirubinemia in acute appendicitis and its complications

Background: To increase diagnostic accuracy and to decrease complication rates secondary to acute appendicitis, a variety of different approaches have been described, including predictive scoring systems. To prevent the catastrophic effects of perforated appendix, a surgeon needs diagnostic tools which may signal perforation of appendix at earliest, as a result of which the delay in the management of perforated appendix will not be witnessed. Keeping in view the above facts, the diagnostic value of serum bilirubin in acute appendicitis and its complications has been evaluated.Methods: This prospective study was conducted on 100 patients who presented with clinical diagnosis of Acute Appendicitis. Role of serum bilirubin as a diagnostic tool in acute appendicitis and diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation was evaluated. . Estimation of serum bilirubin was done by Jendrassik and Gorf method using Hitachi – 912 automatic biochemistry analyzer. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the investigations in the diagnosis of the acute appendicitis were calculated.Results: Serum bilirubin levels had a sensitivity of 84.1% and specificity of 83.3% in the diagnosis of acute appendicitis. The mean bilirubin level of patients with gangrenous appendicitis (2.1±1.2mg/dl) was significantly higher than the mean bilirubin level of patients with simple acute appendicitis (1.5 ±0.6) (p1=0.030 sig). A statistically significant difference was also observed in the mean bilirubin level of patients with perforated appendicitis (mean=2.9±1.6mg/dl) and mean bilirubin level of patients with simple acute appendicitis (p2=<0.0001 sig). However statistically non-significant difference was observed between the mean bilirubin level of patients with gangrenous and perforated appendicitis (p3=0.056 non- sig).Conclusions:Pre-operative assessment of serum bilirubin not only helps in acute appendicitis but also serves as a predictive factor for appendiceal perforation.

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Diagnostic value of serum bilirubin in appendicular perforation

International Surgery Journal ◽

10.18203/2349-2902.isj20174513 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3445

Author(s):

Mallikarjuna M. N. ◽

Utpala Uday

Keyword(s):

Acute Appendicitis ◽

Analytical Study ◽

Serum Bilirubin ◽

Histopathological Examination ◽

Perforated Appendicitis ◽

Liver Function Tests ◽

Diagnostic Value ◽

Total Serum ◽

P Value ◽

The Mean

Background: Hyperbilirubinemia has been well documented in relation to acute appendicitis. This study tries to establish the diagnostic value of this parameter in determining the severity of acute appendicitis.Methods: This is a prospective analytical study conducted on 100 patients with acute appendicitis. All patients were subjected to clinical evaluation and investigations; including liver function tests. The diagnosis was confirmed peri-operatively and postoperatively by histopathological examination. The data was compiled and analysed.Results: The incidence of complicated appendicitis was found to be 18%, defined as evidence of gangrene, or microscopic or gross perforation on histopathological examination. Among these total serum bilirubin (TSB) was raised in 17 cases (17%) and statistically significant correlation was established by p-value <0.001. The mean of TSB level was higher in perforated appendicitis than in cases of acute appendicitis (0.57±0.26 mg/dL; range 0.1-1.2 versus 1.68±1.09 mg/dL; range 0.8-4.8 mg/dL). TSB was shown to have specificity of 96.4%, sensitivity 88.2%, PPV 83.3% and NPV was 97.6%. The diagnostic accuracy of raised bilirubin for diagnosis of appendicular perforation was calculated to be 95.0%. The rise in bilirubin was mixed in type (both indirect and direct). There could not be established any correlation between the liver enzymes and appendicitis or its complications.Conclusions: This study ascertains the predictive value of serum bilirubin in acute appendicitis patients as an indicator of severity. Raised bilirubin in the setting of acute appendicitis identifies higher probability of appendicular perforation.

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C-reactive protein and total serum bilirubin as a predictor of perforated appendicitis: a cross sectional study

International Surgery Journal ◽

10.18203/2349-2902.isj20182776 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2574

Author(s):

Anil Reddy Pinate ◽

Shivakumar C. R. ◽

Mohammad Fazelul Rahman Shoeb ◽

Sharangouda Patil

Keyword(s):

Acute Appendicitis ◽

Serum Bilirubin ◽

Perforated Appendicitis ◽

Diagnostic Value ◽

Total Serum Bilirubin ◽

Total Serum ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Perforated Appendix

Background: C-reactive protein (CRP) and bilirubin have been used as adjuncts for diagnosis of appendicitis. This study assessed the diagnostic value of these markers in patients with suspected acute appendicitis.Methods: CRP values and total serum bilirubin among the patients who presented with acute appendicitis were compared among patients who had perforated appendix and non- perforated appendix. The diagnostic value of CRP and TSB markers as a predictor for perforation were compared in terms of Sensitivity, specificity, PPVs and NPV and the diagnostic accuracy assessed by AUC using receiver operating characteristic (ROC) curve analysis.Results: This study showed sensitivity is 72.50%, specificity of 92.23%, positive predictive value of 78.38% for a raised CRP. The sensitivity of TSB for predicting perforation is 77.50 and the values of specificity, PPV and NPV of the same are 87.38 %, 70.45% and 90.91% respectively. The area under curve was more for CRP than TSB indicating that CRP is better predictor for perforation in appendicitis as compared to the TSB.Conclusions: Thus, serum CRP and total serum bilirubin (TSB) can be used as useful markers for early diagnosis and prediction of perforation in cases of acute appendicitis.

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Effect of Addition of Probiotics to Standard Treatment on Neonatal Jaundice

Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University ◽

10.48036/apims.v17i2.494 ◽

2021 ◽

Vol 17 (2) ◽

pp. 199-203

Author(s):

Tehreem Afzal ◽

Naveed Butt ◽

Shahzad Munir ◽

Nazish Zia

Keyword(s):

Bilirubin Level ◽

Neonatal Jaundice ◽

Standard Treatment ◽

Serum Bilirubin ◽

Serum Bilirubin Level ◽

Combination Group ◽

Medical Institute ◽

Significant Difference ◽

The Mean ◽

Time Required

Objective: To compare the mean change in the bilirubin levels with addition of probiotics to standard treatment for the management of neonatal jaundice. Methodology: The randomized controlled trial was undertaken at the Neonatal Intensive Care Unit of the Paediatrics Department, Federal Government Polyclinic (Post Graduate Medical Institute), Islamabad from 1st April to 30th September 2019. Neonates with hyperbilirubinemia requiring phototherapy were randomly divided into two groups, each having 30 patients. Group A received probiotics along with phototherapy while group B received phototherapy alone. Primary outcome was serum total bilirubin, which was calculated on 0, 1 and 3 days of treatment. Duration of phototherapy and patient's outcome was also recorded. Data was analyzed statistically using SPSS v. 23. Results: The mean serum bilirubin level after 24 hours was 14.27 ± 4.35 mg/dl in combination group while 16.43 ± 4.36 mg/dl in phototherapy group (p > 0.05). After 48 hours, the mean serum bilirubin level was 12.37 ± 3.33 mg/dl in combination group while 14.09 ± 3.60 mg/dl in phototherapy group (p > 0.05). After 72 hours, the mean serum bilirubin level was 11.09 ± 2.87 mg/dl in combination group while 11.72 ± 2.96 mg/dl in phototherapy group (p > 0.05). The mean time required of blue light phototherapy was 43.47 ± 20.71 hours in combination group while 61.53 ±28.27 hours in phototherapy group (p < 0.05). All neonates were discharged. Conclusion: Addition of probiotics to standard treatment decreased the time required for the phototherapy in neonatal jaundice. However no statistically significant difference was seen in the bilirubin levels between the two groups.

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ROLE OF HYPERBILIRUBINEMIA IN PREDICTON OF GANGRENOUS/PERFORATED APPENDICITIS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i7.2011 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

Irfan Hussain Khan ◽

Arun Bhargava

Keyword(s):

Acute Appendicitis ◽

Prospective Study ◽

Bilirubin Level ◽

Diagnostic Tool ◽

Liver Enzymes ◽

Serum Bilirubin ◽

Perforated Appendicitis ◽

Total Serum Bilirubin ◽

Total Serum

Introduction: The aim of this study was to determine the role of hyperbilirubinemia as a new diagnostic tool for predictor of gangrenous / perforated appendicitis. Methods: Hospital based prospective study was conducted on 100 patients with perforated/gangrenous appendix Results: In acute appendicitis case out of 84 cases 26 cases bilirubin level was more than 1mg/dl, in gangrenous appendicitis out of 3 cases all cases bilirubin level was more than 1mg/dl and in perforated appendicitis out of 13 cases 12 cases bilirubin level was more than 1mg/dl Conclusion: It is concluded from present study that elevated total serum bilirubin without elevation of liver enzymes is a good indicator of appendicular perforation. Keywords: Perforation, Appendicitis, Bilirubin

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ROLE OF HYPERBILIRUBINEMIA, ELEVATED CREACTIVE PROTEIN AND LEUCOCYTE COUNT AS A PREDICTIVE FACTOR FOR APPENDICEAL PERFORATION IN ACUTE APPENDICITIS

10.36106/paripex/2101797 ◽

2021 ◽

pp. 1-3

Author(s):

Nagendra Singh Bhadauria ◽

Pawan Kumar ◽

Gunjan Sharma ◽

Amit Singh

Keyword(s):

Acute Appendicitis ◽

Tertiary Care ◽

Diagnostic Value ◽

Primary Data ◽

Laboratory Marker ◽

Reactive Protein ◽

Life Threatening ◽

Perforated Appendix ◽

Appendiceal Perforation

Background: Appendiceal perforation in patients with acute appendicitis may cause a variety of potentially life-threatening complications. Escherichia coli endotoxin has been shown to impact physiological bile flow in vivo. This had led to the theory that hyperbilirubinemia and elevated CRP in patients with appendicitis may have a predictive potential for the preoperative diagnosis of appendiceal perforation. Objectives: The aim of this retrospective study was to investigate the diagnostic value of hyperbilirubinemia and elevated CRP as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis. Thus a new marker for appendiceal perforation would be welcomed. Thus, the need for the study is to conclude whether the Serum Bilirubin or CRP can be considered as a new laboratory marker to aid in the diagnosis of Appendicular Perforation. Materials and methods: All patients admitted with clinical diagnosis of "Acute Appendicitis" or "Appendicular Perforation" and undergoing surgery in General Surgery Dept in Tertiary Care Teaching Hospital were taken as Subjects for this study. The primary data for this study were the blood investigations of the patients. 200 patients with concerned consent and meeting the inclusion criteria were included in the study. The necessary clinical and lab details were obtained in a prewritten format. The intraoperative findings were noted and documented precisely. Upon completion of data collection the preoperative bilirubin levels of the perforated and uncomplicated groups wereOther clinical and lab parameters obtained during the study were compared between the two groups. All parameters were subjected to statistical analysis and evaluated critically. Results: A total of 200 patients participated in the study. Of the 200 patients studied 132 patients were males and 68 patients were females. The youngest patient was 13 years old and the oldest 64 years. Among all the patients operated with a diagnosis of Acute Appendicitis 92 were found to have a perforated appendix, and 108 were found to have a non-perforated appendix. It was observed that among 92 patients with perforated appendix 86 patients showed a raised CRP levels and 58 patients had a raised Bilirubin levels. However in case of non-perforated cases it was found that among the 108 cases 82 patients had a raised CRP levels and 36 patients showed raised bilirubin levels. Conclusion: Hence Logistic Regression technique revealed that the C- reactive protein and Hyperbilirubinemia can be used to predict the appendicular perforation preoperatively and that their roles are comparable and that there is no definitive advantage of one over the other for the same.

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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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A study on the role of raised serum bilirubin levels in acute appendicitis and its outcomes

International Surgery Journal ◽

10.18203/2349-2902.isj20191870 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1561

Author(s):

Abhilash Madhavan ◽

Lakshmana Raman

Keyword(s):

Acute Appendicitis ◽

Bilirubin Level ◽

Serum Bilirubin ◽

Elevated Serum ◽

Perforated Appendicitis ◽

Serum Bilirubin Level ◽

Inclusion Criteria ◽

Predictive Capacity ◽

College Hospital ◽

Medical College

Background: Acute appenidictis is the most common general surgical emergency and early surgical intervention improves outcomes. Despite the increased use of ultrasonography, computed tomography and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%) as has the rate of appendicular perforation. Thus, elevated serum bilirubin level will help in the early and accurate diagnosis of acute appendicitis and if so does it have the predictive capacity to warn us about appendicular perforation.Methods: In this study 100 patients were selected as per satisfaction of the inclusion criteria. This study was carried out at SRM medical college hospital between July 2017 to October 2018. All the data findings were recorded and were analysed.Results: In this study 100 patients were selected on satisfying the inclusion criteria. The serum bilirubin levels were recorded for all these patients. Based on the study it was found out that the serum bilirubin levels was elevated in majority of the cases of acute appendicitis and markedly elevated in case of perforated appendicitis. Though the results were not statistically significant the study seems to be clinically significant.Conclusions: Serum bilirubin level seems to be a reliable diagnostic marker for predicting acute appendicitis and perforated or gangrenous appendicitis.

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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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Diagnostic Value of Interleukin-6 and C-Reactive Protein in Acute Appendicitis

Swiss Surgery ◽

10.1024/1023-9332.6.4.169 ◽

2000 ◽

Vol 6 (4) ◽

pp. 169-172 ◽

Cited By ~ 26

Author(s):

Erkasap ◽

Ates ◽

Ustuner ◽

Sahin ◽

Yilmaz ◽

...

Keyword(s):

Acute Appendicitis ◽

Interleukin 6 ◽

Iliac Fossa ◽

Diagnostic Value ◽

C Reactive Protein ◽

Reactive Protein ◽

Perforated Appendix ◽

Right Iliac Fossa Pain ◽

The Mean ◽

Serum Crp

The aim of this study is prospectively to evaluate the serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels in detection of acute appendicitis in patients with right iliac fossa pain. Data were collected in prospective manner on 102 consecutive patients with right iliac fossa pain. Laparotomy was performed for suspected acute appendicitis for 55 of the 102 patients, of whom 49 patients had appendicitis, 6 patients non-appendicitis (NA), and the other 47 patients had nonspecific abdominal pain (NSAP) and they did not undergo operation. Among those with appendicitis 31 had acute appendix (AA), 8 had gangrenous appendix (GA), and 10 had perforated appendix (PA). The WBC and CRP the mean (SEM) values were significantly different in AA, GA, and PA groups compared with NSAP and NA groups (P < 0.05). Although the mean IL-6 levels were significantly different only in PA group than the others groups (P < 0.05). The sensitivity and specificity of serum CRP measurements were calculated as 96% and 87%, respectively whereas these were 33% and 83% for IL-6 levels for the diagnosis of the acute appendicitis. As a result, measurement of the CRP levels and WBC have an additional diagnostic value on the diagnosis of the acute appendicitis but determination of IL-6 levels which added to the test combination of WBC and CRP, the sensitivity for the diagnosis of the acute appendicitis was not changed whereas the specificity was decreased to 66%.

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