Assessing the Diagnostic Value of Serum Total Bilirubin in Appendicitis: A Prospective Cross-Sectional Study

Background

Despite advancements in diagnostic methodologies, including advanced imaging techniques and laboratory markers, the medical community continues to search for more reliable, accessible, and cost-effective prognostic indicators. This study aims to investigate the predictive utility of serum total bilirubin in appendicitis.

Materials and Methods

A prospective cross-sectional study was conducted with 100 subjects who were clinically suspected of presenting with acute appendicitis or appendicular perforation and were aged over 18 years. The routine biochemical test, complete blood count, liver function test, and ultrasonograph scan was performed on all the participants for pre operative diagnosis. The pre-operative diagnosis was compared with post-operative findings based on histopathology and operative records. The sensitivity and specificity of total bilirubin in detecting appendicitis severity were measured.

Results

The average total bilirubin level in acute appendicitis was 0.74 ± 0.25 mg/dL, gangrenous appendix was 1.96 ± 20 mg/dL, and perforated appendix was 1.78 ± 0.35 mg/dL. When segregated based on total bilirubin cutoff value of 1.2 mg/dL, 81.15% of cases exhibited acute appendicitis, 16.6% manifested a gangrenous appendix, and 4% presented with a perforated appendix among individuals with a total bilirubin level <1.2 mg/dL. Conversely, 18.8% showcased acute appendicitis, 83.3% displayed a gangrenous appendix, and 96% exhibited a perforated appendix among subjects with a total bilirubin level >1.2 mg/dL. A statistically significant variance was detected between total bilirubin levels below 1.2 mg/dL and those exceeding 1.2 mg/dL among various appendicitis. The sensitivity and specificity of total bilirubin in detecting acute appendicitis were 86.7% and 65.9%, for gangrenous appendix 89.06% and 62.63%, and for perforated appendix 89.6% and 65.25%, respectively.

Conclusion

The study concluded that A total bilirubin level below 1.2 mg/dL typically indicates acute appendicitis, while a level above 1.2 mg/dL is often associated with complicated appendicitis.