Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis
Received 30 July 2008; received in revised form 29 August 2008 published online 23 March 2009.
Abstract
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 in patients with appendicitis may have a predictive potential for the preoperative diagnosis of appendiceal perforation. The aim of this retrospective study was to investigate the diagnostic value of hyperbilirubinemia as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis.
Methods
We identified 538 patients (306 female; 232 male, mean age, 35.6 y) with histologically proved acute appendicitis who underwent laparoscopic or conventional appendectomy between January 2004 and December 2007 in a surgical department of an academic teaching hospital. A retrospective multiple chart review of the medical records including laboratory values and histologic results was conducted.
Results
The mean bilirubin level of all patients was .9 mg/dL (±.6 SD mg/dL; range, .1–4.3 mg/dL; median, .7 mg/dL). Patients with appendiceal perforation, however, had a mean bilirubin level of 1.5 mg/dL (±.9 SD mg/dL; range, .4–4.3 mg/dL; median, 1.4 mg/dL), which was significantly higher than those with a nonperforated appendicitis (P < .05). The specificity of hyperbilirubinemia for appendiceal perforation was .86 compared with .55 for white blood count and .35 for C-reactive protein. Sensitivity was .7 compared with .81 for white blood count and .96 for C-reactive protein.
Conclusions
Patients with hyperbilirubinemia and clinical symptoms of appendicitis should be identified as having a higher probability of appendiceal perforation than those with normal bilirubin levels.
aDepartment of General and Visceral Surgery, Augusta Krankenanstalt, Academic Teaching Hospital of the Ruhr University, Bochum, Bergstr. 26, 44791, Bochum, Germany
bDepartment of Dermatology and Allergology, Ruhr University Bochum, Bochum, Germany
cDepartment of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Germany
dDepartment of Physiological Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
ABSTRACT