title: Serum total bilirubin elevation is a predictor of the clinicopathological severity of acute appendicitis.
abstract: OBJECTIVE
  Elevation of the serum total bilirubin (STB) level not stemming from hepatic dysfunction or biliary obstruction may be seen in cases of acute appendicitis. This paper deals with the clinical significance of such elevations.
  
  
  METHODS
  Data from 410 appendectomized patients classified into two groups (a high preoperative STB group and a normal preoperative STB group) were analyzed to reveal the significance of preoperative hyperbilirubinemia. We also examined whether the preoperative STB level might serve as a risk factor for gangrenous appendicitis by a multivariate analysis.
  
  
  RESULTS
  Gangrenous appendicitis was more common in the high preoperative STB group (p < 0.001). The multivariate analysis revealed that an elevated preoperative STB level (odds ratio 1.7919) was a risk factor for gangrenous appendicitis.
  
  
  CONCLUSIONS
  In patients with an elevated preoperative STB level, it is very likely that the inflammation is severe and that the disease has progressed to a severe condition histopathologically; therefore, meticulous attention should be paid to the selection of the surgical procedure, as well as to the postoperative clinical course.
authors.affiliation: Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital, 1-396, Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nomura
authors.forename: Masanori
authors.initials: M
authors.lastname: Watanabe
authors.forename: Osamu
authors.initials: O
authors.lastname: Komine
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shioya
authors.forename: Tetsutaka
authors.initials: T
authors.lastname: Toyoda
authors.forename: Hideki
authors.initials: H
authors.lastname: Bou
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shibuya
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D001065:Appendix / Q000473:pathology*; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D005734:Gangrene / Q000175:diagnosis; D006801:Humans; D006932:Hyperbilirubinemia; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001663:Bilirubin