title: Elevated serum bilirubin in assessing the likelihood of perforation in acute appendicitis: a diagnostic meta-analysis.
abstract: Hyperbilirubinemia associates with perforated acute appendicitis, but the precise test characteristics have not been determined by sufficiently powered studies. A systematic literature search of reports on hyperbilirubinemia in acute appendicitis was performed. After review and quality assessment of eight studies encompassing a total of 4974 patients the sensitivity, specificity and other measures of accuracy of hyperbilirubinemia as a predictor of perforation in acute appendicitis were pooled using a random-effects model. Summary estimates for hyperbilirubinemia (cutoff 1 mg/dl) as a predictor of perforation in acute appendicitis were as follows: sensitivity, 0.49 (95% confidence interval [CI], 0.45-0.52); specificity, 0.82 (95% CI, 0.80-0.83); positive likelihood ratio, 2.51 (95% CI, 1.58-4.00); negative likelihood ratio, 0.58 (95% CI, 0.44-0.76); diagnostic odds ratio was 4.42 (95% CI, 2.21-8.83). In summary receiving operating characteristic (SROC) analysis, the area under curve was 0.73. The presence of hyperbilirubinemia does not alone distinguish a perforation in acute appendicitis. Serum bilirubin level is of some value as a predictor of appendiceal perforation. Patients with hyperbilirubinemia combined with symptoms and signs consistent with severe acute appendicitis should be considered for early appendectomy.
authors.affiliation: Department of Surgery, Turku University Hospital and the University of Turku, Turku, Finland. Electronic address: salvatoregiordano@yahoo.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Giordano
authors.forename: Markus
authors.initials: M
authors.lastname: Pääkkönen
authors.forename: Paulina
authors.initials: P
authors.lastname: Salminen
authors.forename: Juha M
authors.initials: JM
authors.lastname: Grönroos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000097:blood* / Q000453:epidemiology; D001663:Bilirubin / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D012372:ROC Curve; D055815:Young Adult
chemical_list: D001663:Bilirubin
keywords: Appendicitis; Bilirubin; Diagnostic meta-analysis; Hyperbilirubinemia; Jaundice