Hyperbilirubinaemia alone cannot distinguish a perforation in acute appendicitis

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 s 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. Conclusion This meta‐analysis showed that the value of hyperbilirubinaemia alone cannot predict acute perforated appendicitis.