The role of high serum bilirubin as a predictor of complicated appendicitis: a retrospective cohort study

Abstract

Introduction: An appendectomy is one of the most common emergency surgeries. The delay in diagnosis and treatment of appendicitis can lead to complicated appendicitis. The definitive predictive factor that can diagnose complicated appendicitis is still lacking. The authors aim to assess the role of high serum bilirubin level as a predictor of complicated appendicitis. Methods: A retrospective cohort study was conducted among patients with acute appendicitis (AA) between March 2017 and March 2018. Appendicitis cases diagnosed with the help of the Alvarado score undergoing surgery were taken in study and based on the histopathological report, the cases were classified into two groups: uncomplicated and complicated. Preoperatively, biochemical parameters like increased white blood cell count (>11000/cubic millimeter), and level of serum bilirubin >1.4 mg/dl were studied. Informed written consent for the study was taken from the patients with AA. A χ 2 test was applied for the association between categorical variables. Statistical analysis was done with a statistical package for the social sciences (SPSS) version 20; P-value less than 0.05 was considered statistically significant. Results: A total of 100 patients were enrolled in the study with a mean age of 31.2±18.3 years, and 60% were male. Seventy-four (74%) had uncomplicated appendicitis and 26 (26%) had complicated appendicitis. Mean bilirubin was 1.2±0.8 mg/dl in uncomplicated and 1.8±0.8 mg/dl in complicated groups (P <0.05). The sensitivity and specificity of hyperbilirubinemia as a predictor of complicated appendicitis were 50 and 78.38%, respectively. Conclusion: The study revealed that patients with AA and a higher serum bilirubin level have a higher risk of having complicated appendicitis. Serum bilirubin level helps to predict complicated appendicitis and thus plan for timely and appropriate management. Thus, the study concludes that bilirubin should be used together with clinical examination and other laboratory investigations in the assessment of patients with suspected AA.