Diagnostic Accuracy of Serum Bilirubin in Predicting Appendiceal Perforation: A Prospective Study in a Tertiary Care Hospital

Open Access

Abstract

Introduction: Among patients with acute appendicitis, early identification of appendiceal perforation is important for appropriate clinical decision-making. Because hyperbilirubinemia has been associated with complicated appendicitis, serum bilirubin may provide a simple adjunctive marker for predicting perforation. Aim of the study: To evaluate the diagnostic accuracy of serum bilirubin for predicting appendiceal perforation among patients with acute appendicitis. Methods & Materials: In this prospective observational study, 72 patients aged ≥15 years with suspected acute appendicitis who underwent appendectomy at 250 Bedded General Hospital, Brahmanbaria, from July 2023 to June 2024 were included. Before surgery, total serum bilirubin and alanine aminotransferase were measured, and hyperbilirubinemia was defined as serum bilirubin ≥1.1 mg/dL. Following appendectomy, histopathological examination was used to classify patients as having uncomplicated or complicated appendicitis. Receiver operating characteristic analysis was used to assess the diagnostic performance of serum bilirubin. Results: Among 72 patients, 49, 68.06%, had uncomplicated acute appendicitis and 23, 31.94%, had appendiceal perforation or complicated appendicitis. A significantly higher mean serum bilirubin level was observed in the complicated group compared with the uncomplicated group, 1.59 ± 0.61 versus 0.95 ± 0.29 mg/dL, p<0.001. Hyperbilirubinemia was present in 73.91% of complicated cases compared with 20.41% of uncomplicated cases and was associated with higher odds of complicated appendicitis, OR 11.05, 95% CI 3.46-35.30, p<0.001. At a bilirubin cutoff of ≥1.17 mg/dL, sensitivity was 73.91%, specificity 89.80%, positive predictive value 77.27%, and negative predictive value 88.00%. Receiver operating characteristic analysis demonstrated an AUC of 0.84, 95% CI 0.735-0.945, p<0.001. Conclusion: Serum bilirubin showed good discriminatory ability for appendiceal perforation and may be useful as a readily available adjunctive marker for identifying complicated acute appendicitis.