title: Hyperbilirubinemia as a predictive factor in acute appendicitis.
abstract: OBJECTIVE
  Our aim was to establish the role of hyperbilirubinemia as a predictive parameter for the prediction of either acute, or gangrenous/perforated appendicitis as well as to compare other parameters in a similar role.
  
  
  METHODS
  Medical files of the patients who underwent appendectomies between September 2013 and September 2014 were evaluated. Age, gender, preoperative white blood cell count (WBC), neutrophil count (NEU), neutrophil percentage (NEU%), C-reactive protein (CRP), total/direct/indirect bilirubin levels, and the postoperative histopathological findings were recorded. The Fisher's exact, Pearson's χ (2), ANOVA, and Kruskal-Wallis tests while logistic regression for multivariate analysis was performed. p < 0.05 was accepted as statistically significant.
  
  
  RESULTS
  The study group of 162 patients consisted of 97 (60 %) men and 65 (40 %) women with a median age of 36 (18-90). Histopathological examinations revealed normal appendix in 21 (13 %) patients, non-complicated acute appendicitis in 100 (62 %), and appendiceal gangrene/perforation in 41 (25 %) patients. WBC, NEU, NEU%, and CRP levels were significantly higher in cases of acute and gangrenous/perforated appendicitis (p < 0.01). Total and direct bilirubin levels were also significantly elevated in patients with acute and gangrenous/perforated appendicitis (p < 0.01). According to multivariate analysis, elevated CRP levels were associated with 14 times, elevated total bilirubin levels were associated with five times, and elevated direct bilirubin levels were associated with 36 times greater risk for appendiceal gangrene/perforation (p < 0.01, p < 0.05, p < 0.01, respectively).
  
  
  CONCLUSIONS
  Hyperbilirubinemia, especially with elevated direct bilirubin levels, may be considered as an important marker for the prediction of appendiceal gangrene/perforation.
authors.affiliation: Department of General Surgery, School of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Dr. Erkin Street, Kadikoy, 34730, Istanbul, Turkey. drtunceren@gmail.com.
authors.forename: T
authors.identifier: http://orcid.org/0000-0001-7651-4321
authors.initials: T
authors.lastname: Eren
authors.affiliation: Department of General Surgery, School of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Dr. Erkin Street, Kadikoy, 34730, Istanbul, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Tombalak
authors.affiliation: Department of General Surgery, School of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Dr. Erkin Street, Kadikoy, 34730, Istanbul, Turkey.
authors.forename: I A
authors.initials: IA
authors.lastname: Ozemir
authors.affiliation: Department of General Surgery, School of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Dr. Erkin Street, Kadikoy, 34730, Istanbul, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Leblebici
authors.affiliation: Department of Thoracic Surgery (Medical Statistics), School of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Ziyade
authors.affiliation: Department of General Surgery, School of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Dr. Erkin Street, Kadikoy, 34730, Istanbul, Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Ekinci
authors.affiliation: Department of General Surgery, School of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Dr. Erkin Street, Kadikoy, 34730, Istanbul, Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Alimoglu
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D001064:Appendicitis / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D001065:Appendix / Q000293:injuries / Q000378:metabolism; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005734:Gangrene / Q000097:blood / Q000150:complications / Q000175:diagnosis; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D001663:Bilirubin
keywords: Acute appendicitis; Gangrene; Hyperbilirubinemia; Perforation