title: Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis.
abstract: BACKGROUND
  Appendiceal perforation in patients with acute appendicitis may cause a variety of potentially life-threatening complications. Escherichia coli endotoxin has been shown to impact physiological bile flow in vivo. This had led to the theory that hyperbilirubinemia in patients with appendicitis may have a predictive potential for the preoperative diagnosis of appendiceal perforation. The aim of this retrospective study was to investigate the diagnostic value of hyperbilirubinemia as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis.
  
  
  METHODS
  We identified 538 patients (306 female; 232 male, mean age, 35.6 y) with histologically proved acute appendicitis who underwent laparoscopic or conventional appendectomy between January 2004 and December 2007 in a surgical department of an academic teaching hospital. A retrospective multiple chart review of the medical records including laboratory values and histologic results was conducted.
  
  
  RESULTS
  The mean bilirubin level of all patients was .9 mg/dL (+/-.6 SD mg/dL; range, .1-4.3 mg/dL; median, .7 mg/dL). Patients with appendiceal perforation, however, had a mean bilirubin level of 1.5 mg/dL (+/-.9 SD mg/dL; range, .4-4.3 mg/dL; median, 1.4 mg/dL), which was significantly higher than those with a nonperforated appendicitis (P < .05). The specificity of hyperbilirubinemia for appendiceal perforation was .86 compared with .55 for white blood count and .35 for C-reactive protein. Sensitivity was .7 compared with .81 for white blood count and .96 for C-reactive protein.
  
  
  CONCLUSIONS
  Patients with hyperbilirubinemia and clinical symptoms of appendicitis should be identified as having a higher probability of appendiceal perforation than those with normal bilirubin levels.
authors.affiliation: Department of General and Visceral Surgery, Augusta Krankenanstalt, Academic Teaching Hospital of the Ruhr University, Bochum, Bergstr. 26, 44791, Bochum, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Sand
authors.forename: Falk G
authors.initials: FG
authors.lastname: Bechara
authors.forename: Tim
authors.initials: T
authors.lastname: Holland-Letz
authors.forename: Daniel
authors.initials: D
authors.lastname: Sand
authors.forename: Gudrun
authors.initials: G
authors.lastname: Mehnert
authors.forename: Benno
authors.initials: B
authors.lastname: Mann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein