Hyperbilirubinemia as a diagnostic marker in gangrene or perforation of acute appendicitis

Background. Although several scoring systems are available for the diagnosis of acute appendicitis, there is no one specific for the diagnosis of gangrenous or perforated appendicitis. This study aims to evaluate the sensitivity and specificity of serum total bilirubin in gangrene or perforated appendicitis. Materials and Methods. A prospective study was conducted on 55 patients undergoing emergency appendectomy, in whom total serum bilirubin was determined for statistical analysis. Results. In our study, out of 55 patients with a perforated or non-perforated appendix, the mean total serum total bilirubin was 2.34 and 1.27, respectively. The cut-off value of serum total bilirubin in this study was calculated using the ROC curve and found to be 1.75. Hyperbilirubinemia is 92.7% sensitive and 96.4% specific in perforation or gangrene of acute appendicitis. The positive predictive value was 96.2% and the negative predictive value was 93%. Conclusions. Patients with acute appendicitis and increased bilirubin levels have a higher chance of gangrene or perforation than those with normal bilirubin levels. Estimation of total serum bilirubin is available in most centers at minimal cost, and can therefore be used in conjunction with clinical and laboratory investigations for the diagnosis of gangrenous or perforated appendicitis.