title: Hyperbilirubinaemia alone cannot distinguish a perforation in acute appendicitis.
abstract: BACKGROUND
  The objective of the study was to verify the accuracy of hyperbilirubinaemia as a marker for acute perforated appendicitis.
  
  
  METHODS
  A comprehensive search of the MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS, Congress Abstracts and Grey literature from January 1969 to July 2014. We included cross-sectional and cohort studies, prospective and retrospective, which evaluated hyperbilirubinaemia level in perforated appendicitis and compared them with histological analysis of all appendectomy specimens.
  
  
  RESULTS
  Eleven studies were analysed, which included 5395 patients. Pooled sensitivity was 54.6% (95% confidence interval (CI), 42.8-65.8) and specificity was 70.0% (95% CI, 54.7-81.9%) using STATA. The diagnostic odds ratio was 2.82 (95% CI, 1.38-5.72%). Summary receiver operating characteristic curves were constructed. The area under the curve was 0.65.
  
  
  CONCLUSIONS
  This meta-analysis showed that the value of hyperbilirubinaemia alone cannot predict acute perforated appendicitis.
authors: Medical Residency, São José Hospital, Criciuma, Santa Catarina, Brazil.
authors: Fábio R
authors: FR
authors: Silva
authors: Postgraduate Program in Health Sciences, Laboratory of Epidemiology, University of Extremo Sul Catarinense, Criciuma, Santa Catarina, Brazil.
authors: Maria Inês
authors: MI
authors: da Rosa
authors: Medical Residency, Laboratory of Epidemiology, University of Extremo Sul Catarinense, Criciuma, Santa Catarina, Brazil.
authors: Bruno R
authors: BR
authors: Silva
authors: Scientific Initiation Scholarship FUMDES, Laboratory of Epidemiology, University of Extremo Sul Catarinense, Criciuma, Santa Catarina, Brazil.
authors: Carla
authors: C
authors: Simon
authors: Scientific Initiation Scholarship PIC 170, Laboratory of Epidemiology, University of Extremo Sul Catarinense, Criciuma, Santa Catarina, Brazil.
authors: Maria Cecília
authors: MC
authors: Alexandre
authors: Postgraduate Program in Medicine, Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors: Lidia R
authors: LR
authors: Medeiros
authors: Medical Residency, São José Hospital, Criciuma, Santa Catarina, Brazil.
authors: Fabrício S
authors: FS
authors: Bitencourt
authors: Veterinary Medical, Laboratory of Epidemiology, University of Extremo Sul Catarinense, Criciuma, Santa Catarina, Brazil.
authors: Maria Eduarda Fernandes
authors: ME
authors: dos Reis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000097:blood* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000175:diagnosis*; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: appendectomy specimens systematic review; appendiceal perforation; hyperbilirubinaemia; meta-analysis