Evaluation of Serum Bilirubin as a Predictive Marker for Simple and Complicated Appendicitis in Sulaimani Emergency Teaching Hospital

Diagnosis of acute appendicitis can be challenging in some cases as the differentials can be exhaustive. Previous studies have demonstrated that hyperbilirubinemia is a more specific marker for appendicitis than white blood count (WBC) and C-reactive protein (CRP), but this investigation is still not commonly used in the diagnostic workup of appendicitis. This prospective study aims to evaluate serum bilirubin as a laboratory marker for simple and complicated appendicitis. We also investigated the diagnostic value of bilirubin in acute appendicitis and compared it with the WBC. In this prospective study, all patients who underwent appendicectomy at the Sulaimani Emergency Teaching Hospital between 1st November 2016 to 1st January 2017 were included. Preoperative total serum bilirubin was measured and compared with the final histopathology report. Patients were divided into 3 groups: non-inflamed appendix, simple appendicitis and complicated appendicitis. One hundred and 75 patients were analysed, 90 of them were females and 85 were males. Hyperbilirubinemia was found in 63% of patients with complicated appendicitis (p=0.001). Mean of bilirubin was significantly different between patients with complicated appendicitis and non-complicated appendicitis (1.101 vs 0.75 mg/dl; p= 0.0017). Bilirubin had a higher specificity (85%) than WBC (36%), but a lower sensitivity (63% vs 89%) for differentiating complicated appendicitis. Patients with suggestive features of acute appendicitis and raised serum bilirubin indicate a complicated case requiring early intervention to prevent peritonitis and septicaemia. Hyperbilirubinemia is a good indicator for complicated appendicitis and serum bilirubin measurement can be included in the work up of patients with suspected appendicitis.

Download Full-text

Does Serum Bilirubin Add Value in the Diagnosis of Appendicitis? A Multi-Institution Analysis of 2024 Patients

10.21203/rs.3.rs-885174/v1 ◽

2021 ◽

Author(s):

Andrew Phillip Maurice ◽

Benjamin David Swinson ◽

Eduardo Miguel Apellaniz ◽

Sarah Emily King ◽

Thomas Grant Mackay ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Neutrophil Count ◽

Serum Bilirubin ◽

White Cell Count ◽

Delayed Diagnosis ◽

Complicated Appendicitis ◽

Total Serum ◽

Suspected Appendicitis ◽

Uncomplicated Appendicitis ◽

Operative Findings

Abstract BACKGROUNDEven with modern diagnostics, appendicitis can be difficult to diagnose accurately. Negative appendicectomies (NA) and delayed diagnosis of complicated appendicitis (CA, i.e. perforation or abscess) remain common. Serum bilirubin has been proposed as an additional biomarker to assist with the diagnosis of appendicitis. In this large series, we assessed the value of bilirubin in the diagnosis of appendicitis.METHODS A retrospective review of patients with suspected appendicitis at three hospitals over a three year period was performed. All consecutive patients with appendicectomy were included. In addition, a “discharged” sub-group of consecutive patients who were admitted with suspected appendicitis but discharged without an operation was also identified.Demographic data, presence of fever, tachycardia, total white cell count (WCC), neutrophil count, total serum bilirubin, operative findings and final histology were recorded. Multivariate logistic regression was performed to determine independent predictors of appendicitis and CA. Receiver-operator analysis was performed to compare bilirubin to WCC and neutrophil count.RESULTS There were 2024 patients: 1167 had uncomplicated appendicitis, 355 had CA and 303 underwent NA. 200 non-surgical "discharged" patients were included for comparison. Compared to those without appendicitis (NA and discharged groups), increased serum bilirubin was associated with an increased likelihood of appendicitis (OR 1.030 (1.013, 1.048), p<0.0001) and increased likelihood of CA (OR 1.035, 95% CI (1.021, 1.050), p<0.001). These results remained significant when the discharged group, NA group and uncomplicated appendicitis groups were analyzed separately.The sensitivity and specificity of bilirubin was inferior to neutrophil count for the diagnosis of appendicitis (AUC 0.657 versus 0.725, p<0.0001). Bilirubin, WCC and neutrophils each were all relatively insensitive and non-specific over a variety of cut-off values and combinations did not improve their accuracy.CONCLUSION Hyperbilirubinaemia was independently associated with an increased likelihood of both uncomplicated and complicated appendicitis, however had similar sensitivity and specificity when compared to WCC or neutrophils. Bilirubin, neutrophil count and WCC alone are not discriminatory enough to be used in isolation but may be incrementally useful adjuncts in pre-operative assessment of patients with suspected appendicitis.

Download Full-text

Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study

International Surgery Journal ◽

10.18203/2349-2902.isj20171138 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1341 ◽

Cited By ~ 1

Author(s):

Sadhan Kumar Cheekuri ◽

Alok Mohanty ◽

T. Ganesh ◽

R. Kannan ◽

Robinson Smile

Keyword(s):

Observational Study ◽

Acute Appendicitis ◽

Serum Bilirubin ◽

Clinical Signs ◽

Signs And Symptoms ◽

Complicated Appendicitis ◽

Total Serum ◽

P Value ◽

Predictive Capacity ◽

Computed Tomography Scanning

Background: Appendicitis is the most common acute abdominal condition requiring emergency surgery, with a lifetime risk of 6%. Appendectomy continues to be one of the commonest procedures in general surgery, accounts for approximately 1% of all surgical operation. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%). The aim of this study was to whether Serum Bilirubin can 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 complicated appendicitis.Methods: This was prospective observational study done in Mahatma Gandhi Medical College and Research Institute, Pondicherry between November 2014 and August 2016. About 110 patients of acute appendicitis who had undergone appendicectomy were studied. Data was collected and analyzed critically.Results: Males 66 (60%) outnumbered females 44 (40%) and overall mean age was 26.61±12.37 years. Of the 110 patients, 9% were normal appendix, 59.09% were confirmed as acute appendicitis while 31.81% were diagnosed with complicated appendicitis on biopsy. The Sensitivity and Specificity of serum bilirubin as a marker in predicting Acute appendicitis and complicated appendicitis was 47.6% and 90.9% respectively. Similarly, the Positive predicative value and Negative predicative value for the same was 88.5% and 61.5% respectively with odds ratio 12.4 with significant p value <0.0001.Conclusions: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia should be identified as having a higher probability of complicated appendicitis. Hence, serum bilirubin levels have a predictive potential for the diagnosis of severity of acute appendicitis and need for early appendicectomy. If total serum bilirubin is added to already existing laboratory tests, then the diagnosis of complicated appendicitis in clinically suspected cases can be made with fair degree of accuracy, the need for CECT and MRI can be reduced and unnecessary delay in appendicectomy can be avoided.

Download Full-text

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

Download Full-text

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

Download Full-text

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

Download Full-text

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

Download Full-text

Comparison of Sensitivity of TLC and Liver Assay in Diagnosing Appendicitis and Complicated Appendicitis at a Rural Medical Institution

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/557 ◽

2020 ◽

Vol 7 (46) ◽

pp. 2710-2713

Author(s):

Sandeep Kumar Goyal ◽

Vilkram Saini ◽

Minaxi Saini ◽

Gopal Singhal ◽

Kanishak Mehta ◽

...

Keyword(s):

Liver Function ◽

Acute Appendicitis ◽

Serum Bilirubin ◽

Clinical Signs ◽

Liver Function Tests ◽

Complicated Appendicitis ◽

Total Serum Bilirubin ◽

Total Leukocyte Count ◽

Total Serum ◽

Function Tests

BACKGROUND Diagnosis of acute appendicitis is always a challenging task in emergency ward which can most of the time be diagnosed with thorough history and physical examination by surgeon, various clinical signs and laboratory investigations like total leukocyte count (TLC), neutrophils shift to left. Unnecessary surgical interventions of appendix can be reduced by precise diagnosis of levels of TLC and total serum bilirubin values. We wanted to evaluate the sensitivity of laboratory marker like TLC and liver function tests in diagnosing a case of appendicitis and complicated appendicitis. METHODS 100 patients who were admitted in the Department of General Surgery, Maharaja Agrasen Medical Collage, Agroha (Hisar), with clinical diagnosis of acute appendicitis were included in the study. Data was statistically analysed and sensitivity of TLC and liver function test in diagnosing acute appendicitis was compared. RESULTS Sensitivity of TLC was found to be 47 %; that of total serum bilirubin was 72 % which is significant; that of SGOT was 26 %; that of SGPT was 21 % and that of ALP was 8 % in diagnosing acute appendicitis. While comparing sensitivity of this marker to diagnose complicated appendicitis (gangrenous and perforated appendix) it was 56.3 % for TLC, 100 % for total serum bilirubin, 31.3 % for SGOT, 37.5 % for SGPT and 12.5 % for ALP. CONCLUSIONS Raised total serum bilirubin has potential to detect complications of appendicitis and the need for early intervention by surgeon. KEYWORDS Appendicitis; Liver Function Tests; Serum Bilirubin

Download Full-text

Causes of acute peritonitis in 1188 consecutive adult patients in Ghana

Tropical Doctor ◽

10.1258/0049475054036788 ◽

2005 ◽

Vol 35 (2) ◽

pp. 84-85 ◽

Cited By ~ 7

Author(s):

Michael Ohene-Yeboah

Keyword(s):

Acute Appendicitis ◽

Prospective Study ◽

Teaching Hospital ◽

Communicable Diseases ◽

Adult Patients ◽

Emergency Unit ◽

Ileal Perforation ◽

Acute Peritonitis ◽

Generalized Peritonitis ◽

Previous Series

In a five-year prospective study,1188 consecutive adult patients were admitted and treated for acute generalized peritonitis at the Surgical Emergency Unit of the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Appendicitis and typhoid ileal perforation were the commonest causes, occurring in 43.1% and 35.1% of patients, respectively. Other conditions (gastroduodenal perforations, ruptured abscesses, traumatic bowel perforations and amoebic colonic perforations) accounted for fewer than 25% of cases. This paper notes that acute appendicitis and typhoid perforation remain the leading causes of peritonitis in Ghana. Compared with previous series, the importance of appendicitis in acute peritonitis has diminished. The complications of communicable diseases now cause peritonitis more commonly than 35 years ago. This may reflect deteriorating conditions of sanitation and housing during the intervening period.

Download Full-text

Advantage of ultrasonography in the diagnosis of acute appendicitis at Al-Karama Teaching Hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20190467 ◽

2019 ◽

Vol 6 (3) ◽

pp. 702

Author(s):

Mohammed Hillu Surriah ◽

Amine Mohammed Bakkour ◽

Nidaa Ali Abdul Hussain

Keyword(s):

Acute Appendicitis ◽

Teaching Hospital ◽

Predictive Value ◽

Diagnostic Technique ◽

Cost Effective ◽

Cross Sectional Study ◽

Negative Appendectomy ◽

Cross Sectional ◽

Suspected Appendicitis ◽

Presenting Symptoms

Background: The clinical diagnosis of acute appendicitis remains a challenge to surgeons. Different aids were introduced to improve the diagnostic accuracy. Among these modalities, ultrasonography is simple, easily available, non-invasive, convenient and cost effective. The aim of the study was to determine the validity of ultrasound in diagnosis of the acute appendicitis in those with clinically diagnosed patients.Methods: A cross sectional study was carried out in Al-Karama teaching hospital for thirty months from the period of 1st June 2016 to 1st December 2018. All patients with suspected appendicitis underwent clinical evaluation then sent for US. Results of surgeries, where relevant, were compared against US results. Positive and negative appendices on histopathology were regarded in accordance to the criteria which was negative appendectomy was defined as normal looking appendix and absence of acute inflammation on histopathology while positive cases included appendices showing acute inflammatory changes. Sensitivity, specificity and overall accuracy was calculated.Results: A total of 435 patients with suspected appendicitis, males 224 (51.49%) and females 211 (48.50%) were included in present study. There were no significant differences between patients with positive and negative histopathology findings regarding presenting symptoms. There was a significant association between (cough sign, localized tenderness sign and pointing sign) and patients with positive histopathology findings. Regarding to the validity results of ultrasound in comparison to histopathology findings were accuracy 87.6%, sensitivity 87.8%, specificity 85.3%, positive predictive value 98.6% and negative predictive value 62.8%.Conclusions: The ultrasonography had a good accuracy, sensitivity and specificity in diagnosing acute appendicitis cases. Negative with ultrasonography results should be re-examined with different diagnostic technique like CT-scan.

Download Full-text

A three year prospective study-suspected acute appendicitis: diagnostic accuracy of modified Alvarado score versus ultrasonography in adults

International Surgery Journal ◽

10.18203/2349-2902.isj20175145 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3924

Author(s):

Murhari D. Gaikwad ◽

Anand Auti ◽

Avinash Magare

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Prospective Study ◽

Predictive Value ◽

Clinical Decision Making ◽

Clinical Decision ◽

Alvarado Score ◽

Suspected Appendicitis ◽

Modified Alvarado Score ◽

Suspected Acute Appendicitis

Background: To evaluate and compare diagnostic accuracy of modified Alvarado score and ultrasonography in co-relation to histopathology report for diagnosis of acute appendicitis.Methods: A prospective study of the patients who underwent appendectomy for suspected acute appendicitis at IIMS and R Medical College and Noor Hospital Warudi, Badnapur, Dist. Jalna (Maharashtra). The clinical (radiological) and ultrasonography data of 760 patients with suspected appendicitis was collected between March 2014 to Feb. 2017. These patients were evaluated by modified Alvarado score and ultrasonographically, which was corrected with histopathological finding.Results: Out of 760 patients 69.34% had acute appendicitis 63.81% had modified Alvarado score≥7 and 58.28% patients were ultrasonographically positive. In present study modified Alvarado score has sensitivity of 89.37% specificity 93.99% positive predictive value 97.11%, negative predictive value 79.64%, diagnostic accuracy of 81.32%.Conclusions: Modified Alvarado score can be used effectively in clinical decision making. When compare with ultrasonography neither one is advantageous. However, additional information provided by ultrasonography improves diagnostic accuracy.

Download Full-text