Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? a prospective study

Purpose To compare the performance for the prediction of perforated appendicitis of total bilirubin versus C-reactive protein (CRP), white blood cell count, the time period of symptoms' evolution, and systemic inflammatory response syndrome (SIRS). Methods Prospective observational study, applying receiver operating characteristics curve analysis to compare the sensitivity and specificity of the tested variables. Results The period of symptom's evolution was prolonged (105.2 +/- 79.3 hours vs. 38.6 +/- 17.5 hours), and CRP levels were higher in perforated appendicitis (176 +/- 82.6 mg/l vs. 80 +/- 76 mg/l). Most patients with perforated appendicitis had a SIRS score higher than 3 points. CRP (>76.7 mg/l), the time period of symptoms' evolution (>34.5 hours), and SIRS (3 points or more), were the best cutoff values to predict perforated appendicitis. Conclusions Perforated appendicitis may be suspected based on CRP, SIRS and the time period of symptoms' evolution. We do not recommend the use of total bilirubin to predict perforation in appendicitis.