scholarly journals Role of serum bilirubin in predicting the severity of acute appendicitis

2019 ◽  
Vol 6 (12) ◽  
pp. 4415
Author(s):  
Sandeep Y. Chinnapur ◽  
Naveen Kumar S. ◽  
Hanumanthaiah K. S.
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Histopathological Examination ◽  
Serum Total Bilirubin ◽  
Medical College ◽  
Gangrenous Appendicitis ◽  
Routine Investigations

Background: The aim of the study was to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis.Methods: A prospective study carried for 9 months (March 2018 to November 2018) at Rajarajeswari Medical College and Hospital. All patients admitted with clinical diagnosis of acute appendicitis and posted for surgery were included in the study. Serum total bilirubin results will be compared with Rajarajeswari Medical College and Hospitals laboratory reference values. These cases will be operated and clinical diagnosis will be confirmed per-operatively and post-operatively by histopathological examination. Final histopathological examination will be considered as a gold standard for diagnosing and categorizing patients as having normal appendix, acute appendicitis and acute appendicitis with perforation and/or gangrene. Based on histopathological examination patients will be categorized as positive (acute appendicitis with perforation and/or gangrene) and negative (acute appendicitis without perforation or gangrene).Results: Sensitivity of serum bilirubin in case of perforated/gangrenous appendicitis was found to be 90%. Specificity of serum bilirubin was found in case of perforated/gangrenous appendicitis was found to be 90.47%. Positive predictive value and negative predicting value of serum bilirubin in perforated/gangrenous appendicitis was found to be 81.8% and 95% respectively with p value of 0.003.Conclusions:Serum total bilirubin is an easily available and cheap and can be estimated from the same blood sample withdrawn for routine investigations, if added to routine investigations, then diagnosis of complicated appendicitis can be made with fair degree of accuracy.  

scholarly journals Role of Hyperbilirubinemia as a Diagnostic Tool to Predict Gangrenous/Perforated Appendicitis: An Observational Study

2020 ◽  
Vol 3 (1) ◽  
pp. 52-55
Author(s):  
Mohak Mankad ◽  
Pranjal Sangole ◽  
Gyaneshwar Rao
Keyword(s):  
Observational Study ◽  
Acute Appendicitis ◽  
Diagnostic Tool ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Medical Science ◽  
Elevated Serum ◽  
Perforated Appendicitis ◽  
Serum Total Bilirubin

Background: Elevation in serum bilirubin was reported recently, but the importance of the raised total bilirubin has not been stressed in acute appendicitis and appendicular perforation. The aim of the study was to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis. Subjects and Methods: This was a prospective observational study, which was conducted at the Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. A total of 100 patients clinically diagnosed as appendicitis from August 2018 to August 2019 at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. Patients were clinically evaluated by detailed history, routine examination on initial contact with patients and the routine investigations as per surgery and anesthesia requirements with inclusion of serum total bilirubin. Based on histopathological examination patients will be categorized as positive (acute appendicitis with perforation and/or gangrene) and negative (acute appendicitis without perforation or gangrene). Results: Out of 100 patients, 20 were managed conservatively (mass formation) and was called for interval appendectomy after 6 weeks. In acute catarrhal appendicitis group 47 patients showed normal total bilirubin levels, whereas 8 patients showed increase in levels of total bilirubin.  In gangrenous appendicitis group all 10 patients showed elevated serum total bilirubin levels  In perforated appendicitis group consisted of 15, 11 patients showed elevated serum bilirubin levels and 4 patients showed normal total bilirubin levels. Conclusion: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations.

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

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

scholarly journals Role of serum bilirubin as a marker of acute gangrenous appendicitis

2012 ◽  
Vol 1 (2) ◽  
pp. 89-92 ◽  
Author(s):  
P Ghimire ◽  
P Thapa ◽  
N Yogi ◽  
P Ghimire
Keyword(s):  
Logistic Regression ◽  
Leucocyte Count ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Total Bilirubin Level ◽  
Total Serum ◽  
Total Leucocyte Count ◽  
Serum Total Bilirubin ◽  
Gangrenous Appendicitis ◽  
Significant Difference

Background: This study has compared the difference in serum bilirubin between patients with gangrenous and non-gangrenous appendicitis. Methods: A prospective analytical study of, 141 patients who underwent appendectomy, from March 2010 to March 2011 in Manipal Teaching Hospital, Pokhara, Nepal was carried out. Clinico-demographic data, Alvarado’s score, total serum bilirubin, total leucocyte count and histopathological report of all the cases were collected in a prestructured proforma. Comparison between gangrenous and non-gangrenous appendicitis groups was carried out using independent sample t test, Chisquare test, and direct logistic regression. The data was analyzed using SPSS 11.6 software. Result: Around 43% (61 out of 141) patients had gangrenous appendicitis and statistically significant difference was found between the two groups in total Alvarado’s score, total count and total bilirubin level. The effect size as indicated by eta square statistics was large for total bilirubin (eta squared=0.39) as compared to total Alvarado’s score (0.09) and total leucocyte count (0.05). Direct logistic regression model showed serum total bilirubin as the only independent variable to make a unique statistically significant contribution in predicting gangrenous appendicitis. Conclusion: Pre-operative assessment of serum total bilirubin can serve as an important maker of acute gangrenous appendicitis. DOI: http://dx.doi.org/10.3126/njms.v1i2.6606 Nepal Journal of Medical Sciences. 2012;1(2): 89-92

HYPERBILIRUBINEMIA AS AN INDICATOR IN PERFORATED APPENDICITIS

2021 ◽  
pp. 41-49
Author(s):  
Veeresh Kumar Ireddy ◽  
Varun H Kasyap ◽  
Chandan S Bhoomkar
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Serum Bilirubin ◽  
Clinical Signs ◽  
Perforated Appendicitis ◽  
Research Centre ◽  
Bacterial Invasion ◽  
Medical College ◽  
Computed Tomography Scanning ◽  
Elevated Bilirubin

Introduction: Acute appendicitis is one of the most common causes of urgent admission to the hospital.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. 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. Among commonly used inammation markers of Acute appendicitis, bilirubin concentration is not well studied and thus is rarely applied. Every investigation that can contribute towards a diagnosis of appendicitis is valuable to the emergency general surgeon Aim: 1. To study the relationship between hyperbilirubinemia and acute appendicitis; and to evaluate its credibility as a diagnostic marker for acute appendicitis. 2. To evaluate whether elevated bilirubin levels have a predictive potential for the diagnosis of Appendicular perforation. Material and methods: The study was conducted in the Department of General Surgery, Navodaya Medical College & Research centre, Raichur during the period of January 2020 to December 2020.Patients admitted with clinical diagnosis of acute appendicitis or appendicular perforation under the Department of Surgery, Navodaya Medical College & Research centre, Raichur during the study period. A total of 100 patients with clinical diagnosis of acute appendicitis or appendicular perforation were studied. Results: .Normal bilirubin values were seen in 26% patients while, 74% had raised bilirubin levels (Hyperbilirubinemia). Of 81 patients with acute appendicitis, 71.6% had raised bilirubin levels, while 28.4% had normal levels. 19 patients were diagnosed as Appendicular perforation, 16 patients (84.21%) had raised bilirubin levels, while the remaining 03 patients (15.79%) had normal levels.Amongst the patients diagnosed with Acute appendicitis without perforation (n=81), 58 patients (71.6%) were found to have elevated bilirubin (>1.0 mg/dL) while only 23 patients (28.4%) had normal bilirubin levels (≤1.0 mg/dL). In patients diagnosed with Appendicular perforation (n=19), 16 patients (84.21%) had bilirubin elevated (>1.0 mg/dL), while only 3 patients (15.79%) had normal levels (>1.0 mg/dL). Thus, Hyperbilirubinemia was found in most of the patients diagnosed with acute appendicitis (71.6%) or Appendicular perforation (84.21%). Conclusion: The present study suggests- Serum bilirubin levels appears to be a promising new laboratory marker for diagnosing acute appendicitis, however diagnosis of appendicitis remains essentially still - clinical. Its level come out to be a credible aid in diagnosis of acute appendicitis and would be helpful investigation in decision making. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia higher than the normal range should be identied as having a higher probability of Appendicular perforation suggesting, serum bilirubin levels have a predictive potential for the diagnosis of Appendicular perforation.

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

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.

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

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

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

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

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

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

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

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

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

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 ◽  
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 or 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 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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