Hyperbilirubinemia as a New Diagnostic Marker for Acute Appendicitis and its Role as a Predictor of Complicated Appendicitis: A Prospective Study

Aim: The present study was done to assess the relationship between hyperbilirubinemia and acute appendicitis and to evaluate its credibility as a diagnostic marker for acute appendicitis and its predictive potential in diagnosis of complicated appendicitis. Methodology: This one-year cross sectional study was conducted in the department of general surgery, Sree Balaji Medical College and Hospital during the period of April 2018 to April 2019. A total of 100 patients with clinical diagnosis acute appendicitis or complicated appendicitis were studied. The serum bilirubin and liver function tests were carried out in all the patients. Results: In this study, male (58%) outnumbered females (42%) and overall, the mean age was 29. The mean total serum bilirubin of all 100 patients was 1.491 +/- 1.0319 mg/dl which was above the normal range (>1.0 mg.dl) considered for the study, hence indicating the presence of hyperbilirubinemia. The mean of direct bilirubin was 1.290 +/- 0.7483mg/dl while that of indirect bilirubin was 0.504 +/- 0.2494 mg/dl. Among the patients with inflamed appendix, 26 patients (34.66%) were found to have elevated bilirubin (>1.0mg/dl). In patients diagnosed with appendicular perforation (n=25), 19 patients (76%) had bilirubin elevated (>1.0mg/dl), while only 6 patient (24%) had normal level (<1.0 mg/dl). Thus, hyperbilirubinemia was seen in 34.66% of patients with acute appendicitis and 76% of patients with complicated appendicitis. Sensitivity and specificity of bilirubin in diagnosing acute appendicitis and appendiceal perforation was 76% and 65.33% respectively. Similarly positive predictive value and negative predictive value of bilirubin was 42.22% and 89.09%. Conclusion: Serum bilirubin routinely added to the blood investigation can be useful laboratory investigation for aiding in the diagnosis of acute appendicitis. Can be easily done and cheaply available. Patients with three times the normal bilirubin value and clinical signs of appendicitis and appendicular perforation have higher probability of having complicated appendicitis.