Accuracy of hyperbilirubinemia and neutrophil lymphocyte ratio as independent predictors of perforation in acute appendicitis

Objective: To determine the accuracy of hyperbilirubinemia and neutrophil lymphocyte ratio in predicting appendicular perforation. Methodology: This cross sectional study was conducted in surgical department of Polyclinic Hospital, Islamabad, Pakistan from July 14, 2017 to January 14, 2018. Sample size was 383 patients. A non-probability consecutive sampling technique was used. Hyperbilirubinemia was defined as total bilirubin >1mg/dl and neutrophil lymphocyte ratio (NLR) greater than 5 for predicting appendicular perforation, keeping histopathology as standard for perforation. Results: Out 383 patients with acute appendicitis, 227(59%) were male and 156(41%) female. Mean age was 25.5 +/- 10.7 years. 35(9.14%) patients had perforated appendix on histopathology. Hyperbilirubinemia had a sensitivity of 54.3%, specificity of 87.1%, NLR >5 had a sensitivity of 74.3%, specificity of 60%. Conclusions: Hyperbilirubinemia and high NLR should be used in combination with clinical assessment and imaging modalities to improve the diagnostic accuracy for predicting perforation in acute appendicitis.