title: Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? - a prospective study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery, Emergency Unit, Universidad Catolica Del Norte, Hospital De La Serena, La Serena, Chile.
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Beltran
authors.forename: Pedro E
authors.initials: PE
authors.lastname: Mendez
authors.forename: Rodrigo E
authors.initials: RE
authors.lastname: Barrera
authors.forename: Mario A
authors.initials: MA
authors.lastname: Contreras
authors.forename: Christian S
authors.initials: CS
authors.lastname: Wilson
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Cortes
authors.forename: Karina S
authors.initials: KS
authors.lastname: Cruces
keywords: Acute appendicitis; Hepatic dysfunction in sepsis; Hyperbilirubinaemia; Perforated appendicitis