Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation
Aim The aim of this study is to evaluate the diagnostic value of pre-operative bilirubin levels in the diagnosis of acute appendicitis and appendiceal perforation. Method A retrospective analysis of 557 patients undergoing emergency appendicectomy over a 24-month period at a large teaching hospital....
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| Veröffentlicht in: | European journal of trauma and emergency surgery (Munich : 2007) 2016-04, Vol.42 (2), p.249-252 |
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| creator | Adams, H. L. Jaunoo, S. S. |
| description | Aim
The aim of this study is to evaluate the diagnostic value of pre-operative bilirubin levels in the diagnosis of acute appendicitis and appendiceal perforation.
Method
A retrospective analysis of 557 patients undergoing emergency appendicectomy over a 24-month period at a large teaching hospital. Hyperbilirubinaemia was defined as >25 µmol/L. Data were analysed using descriptive statistics.
Results
484 of the 557 (86.9 %) operated cases were found histologically to be appendicitis. 116 cases of the 484 were perforated (24 %). Bilirubin levels were significantly higher in the group with appendicitis versus the group found to have a normal appendix at histology, [median (IQR) 12.0 µmol/L (9.00) vs. 8.0 µmol/L (7.00) respectively,
p
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| doi_str_mv | 10.1007/s00068-015-0540-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1781537411</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4021199211</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-3288d528e3bf7fc2d164da51d334f482ddfa85e2c38fa03fc12ee4180dd186003</originalsourceid><addsrcrecordid>eNp1kU1PAyEURYnRWK3-ADeGxI2b0QfMB3VnGr-SJm50TejwUJopM8KM0X8vTWujJq4gcO59kEPICYMLBlBdRgAoZQasyKDIIfvYIQdMliKbTHK2u90LMSKHMS4SDGXB98mIlyAkFNUB6e8_Owxz17gwzJ3XuHSaOk9116E3rna9i1e0f0VqnH7xbexdTd91MyC1baBdwAT1rvW0tb9CVHuzPUDd0DQmJfSKPSJ7VjcRjzfrmDzf3jxN77PZ493D9HqW1aLifSa4lKbgEsXcVrbmhpW50QUzQuQ2l9wYq2WBvBbSahC2ZhwxZxKMST8HEGNyvu7tQvs2YOzV0sUam0Z7bIeoWCVZIaqcsYSe_UEX7RB8et2KgsTIKk8UW1N1aGMMaFUX3FKHT8VArZSotRKVlKiVEvWRMqeb5mG-RLNNfDtIAF8DMV35Fww_Rv_b-gU2nJkP</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1780741874</pqid></control><display><type>article</type><title>Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Adams, H. L. ; Jaunoo, S. S.</creator><creatorcontrib>Adams, H. L. ; Jaunoo, S. S.</creatorcontrib><description>Aim
The aim of this study is to evaluate the diagnostic value of pre-operative bilirubin levels in the diagnosis of acute appendicitis and appendiceal perforation.
Method
A retrospective analysis of 557 patients undergoing emergency appendicectomy over a 24-month period at a large teaching hospital. Hyperbilirubinaemia was defined as >25 µmol/L. Data were analysed using descriptive statistics.
Results
484 of the 557 (86.9 %) operated cases were found histologically to be appendicitis. 116 cases of the 484 were perforated (24 %). Bilirubin levels were significantly higher in the group with appendicitis versus the group found to have a normal appendix at histology, [median (IQR) 12.0 µmol/L (9.00) vs. 8.0 µmol/L (7.00) respectively,
p
< 0.001], despite being within normal serum bilirubin range. Sensitivity of hyperbilirubinaemia for acute appendicitis was only 8 %, however specificity was 94 %. PPV was 85 % and NPV was 26 %. Whilst bilirubin was higher in patients with a perforated appendix versus acute appendicitis [median (IQR) 13.0 µmol/L (9.00) vs. 11.0 µmol/L (9.00), respectively], statistically, there was no significant difference in pre-operative bilirubin levels between the perforated appendicitis cases and the non-perforated appendicitis cases (
p
= 0.326). However, the specificity of hyperbilirubinaemia for perforated appendicitis was 93 %, sensitivity 9.4 %, PPV 24 % and NPV 82 %.
Conclusion
Bilirubin levels may be high, but remain within normal range, in cases of appendicitis. Therefore, bilirubin levels may be a useful measurement when investigating a patient with suspected appendicitis. Hyperbilirubinaemia is highly specific with regards to perforation, a finding supported by other studies. However, possibly because of the few perforated cases in this study, we cannot recommend that hyperbilirubinaemia be used to predict perforation.</description><identifier>ISSN: 1863-9933</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-015-0540-x</identifier><identifier>PMID: 26038057</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged, 80 and over ; Analysis ; Appendectomy - methods ; Appendectomy - statistics & numerical data ; Appendicitis ; Appendicitis - blood ; Appendicitis - complications ; Appendicitis - diagnosis ; Appendicitis - etiology ; Appendicitis - surgery ; Bilirubin - blood ; Biomarkers - blood ; Child ; Critical Care Medicine ; Emergency Medicine ; Female ; Humans ; Hyperbilirubinemia - complications ; Hyperbilirubinemia - diagnosis ; Intensive ; Male ; Medical diagnosis ; Medicine ; Medicine & Public Health ; Original Article ; Predictive Value of Tests ; Preoperative Period ; Prognosis ; Retrospective Studies ; Risk Assessment ; Sports Medicine ; Studies ; Surgery ; Surgical Orthopedics ; Traumatic Surgery ; United Kingdom</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2016-04, Vol.42 (2), p.249-252</ispartof><rights>Springer-Verlag Berlin Heidelberg 2015</rights><rights>Springer-Verlag Berlin Heidelberg 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-3288d528e3bf7fc2d164da51d334f482ddfa85e2c38fa03fc12ee4180dd186003</citedby><cites>FETCH-LOGICAL-c372t-3288d528e3bf7fc2d164da51d334f482ddfa85e2c38fa03fc12ee4180dd186003</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00068-015-0540-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00068-015-0540-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26038057$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Adams, H. L.</creatorcontrib><creatorcontrib>Jaunoo, S. S.</creatorcontrib><title>Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description>Aim
The aim of this study is to evaluate the diagnostic value of pre-operative bilirubin levels in the diagnosis of acute appendicitis and appendiceal perforation.
Method
A retrospective analysis of 557 patients undergoing emergency appendicectomy over a 24-month period at a large teaching hospital. Hyperbilirubinaemia was defined as >25 µmol/L. Data were analysed using descriptive statistics.
Results
484 of the 557 (86.9 %) operated cases were found histologically to be appendicitis. 116 cases of the 484 were perforated (24 %). Bilirubin levels were significantly higher in the group with appendicitis versus the group found to have a normal appendix at histology, [median (IQR) 12.0 µmol/L (9.00) vs. 8.0 µmol/L (7.00) respectively,
p
< 0.001], despite being within normal serum bilirubin range. Sensitivity of hyperbilirubinaemia for acute appendicitis was only 8 %, however specificity was 94 %. PPV was 85 % and NPV was 26 %. Whilst bilirubin was higher in patients with a perforated appendix versus acute appendicitis [median (IQR) 13.0 µmol/L (9.00) vs. 11.0 µmol/L (9.00), respectively], statistically, there was no significant difference in pre-operative bilirubin levels between the perforated appendicitis cases and the non-perforated appendicitis cases (
p
= 0.326). However, the specificity of hyperbilirubinaemia for perforated appendicitis was 93 %, sensitivity 9.4 %, PPV 24 % and NPV 82 %.
Conclusion
Bilirubin levels may be high, but remain within normal range, in cases of appendicitis. Therefore, bilirubin levels may be a useful measurement when investigating a patient with suspected appendicitis. Hyperbilirubinaemia is highly specific with regards to perforation, a finding supported by other studies. However, possibly because of the few perforated cases in this study, we cannot recommend that hyperbilirubinaemia be used to predict perforation.</description><subject>Adult</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Appendectomy - methods</subject><subject>Appendectomy - statistics & numerical data</subject><subject>Appendicitis</subject><subject>Appendicitis - blood</subject><subject>Appendicitis - complications</subject><subject>Appendicitis - diagnosis</subject><subject>Appendicitis - etiology</subject><subject>Appendicitis - surgery</subject><subject>Bilirubin - blood</subject><subject>Biomarkers - blood</subject><subject>Child</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Humans</subject><subject>Hyperbilirubinemia - complications</subject><subject>Hyperbilirubinemia - diagnosis</subject><subject>Intensive</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Predictive Value of Tests</subject><subject>Preoperative Period</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Sports Medicine</subject><subject>Studies</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Traumatic Surgery</subject><subject>United Kingdom</subject><issn>1863-9933</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kU1PAyEURYnRWK3-ADeGxI2b0QfMB3VnGr-SJm50TejwUJopM8KM0X8vTWujJq4gcO59kEPICYMLBlBdRgAoZQasyKDIIfvYIQdMliKbTHK2u90LMSKHMS4SDGXB98mIlyAkFNUB6e8_Owxz17gwzJ3XuHSaOk9116E3rna9i1e0f0VqnH7xbexdTd91MyC1baBdwAT1rvW0tb9CVHuzPUDd0DQmJfSKPSJ7VjcRjzfrmDzf3jxN77PZ493D9HqW1aLifSa4lKbgEsXcVrbmhpW50QUzQuQ2l9wYq2WBvBbSahC2ZhwxZxKMST8HEGNyvu7tQvs2YOzV0sUam0Z7bIeoWCVZIaqcsYSe_UEX7RB8et2KgsTIKk8UW1N1aGMMaFUX3FKHT8VArZSotRKVlKiVEvWRMqeb5mG-RLNNfDtIAF8DMV35Fww_Rv_b-gU2nJkP</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>Adams, H. L.</creator><creator>Jaunoo, S. S.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20160401</creationdate><title>Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation</title><author>Adams, H. L. ; Jaunoo, S. S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-3288d528e3bf7fc2d164da51d334f482ddfa85e2c38fa03fc12ee4180dd186003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Appendectomy - methods</topic><topic>Appendectomy - statistics & numerical data</topic><topic>Appendicitis</topic><topic>Appendicitis - blood</topic><topic>Appendicitis - complications</topic><topic>Appendicitis - diagnosis</topic><topic>Appendicitis - etiology</topic><topic>Appendicitis - surgery</topic><topic>Bilirubin - blood</topic><topic>Biomarkers - blood</topic><topic>Child</topic><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Humans</topic><topic>Hyperbilirubinemia - complications</topic><topic>Hyperbilirubinemia - diagnosis</topic><topic>Intensive</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Predictive Value of Tests</topic><topic>Preoperative Period</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Sports Medicine</topic><topic>Studies</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Traumatic Surgery</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Adams, H. L.</creatorcontrib><creatorcontrib>Jaunoo, S. 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L.</au><au>Jaunoo, S. S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>42</volume><issue>2</issue><spage>249</spage><epage>252</epage><pages>249-252</pages><issn>1863-9933</issn><eissn>1863-9941</eissn><abstract>Aim
The aim of this study is to evaluate the diagnostic value of pre-operative bilirubin levels in the diagnosis of acute appendicitis and appendiceal perforation.
Method
A retrospective analysis of 557 patients undergoing emergency appendicectomy over a 24-month period at a large teaching hospital. Hyperbilirubinaemia was defined as >25 µmol/L. Data were analysed using descriptive statistics.
Results
484 of the 557 (86.9 %) operated cases were found histologically to be appendicitis. 116 cases of the 484 were perforated (24 %). Bilirubin levels were significantly higher in the group with appendicitis versus the group found to have a normal appendix at histology, [median (IQR) 12.0 µmol/L (9.00) vs. 8.0 µmol/L (7.00) respectively,
p
< 0.001], despite being within normal serum bilirubin range. Sensitivity of hyperbilirubinaemia for acute appendicitis was only 8 %, however specificity was 94 %. PPV was 85 % and NPV was 26 %. Whilst bilirubin was higher in patients with a perforated appendix versus acute appendicitis [median (IQR) 13.0 µmol/L (9.00) vs. 11.0 µmol/L (9.00), respectively], statistically, there was no significant difference in pre-operative bilirubin levels between the perforated appendicitis cases and the non-perforated appendicitis cases (
p
= 0.326). However, the specificity of hyperbilirubinaemia for perforated appendicitis was 93 %, sensitivity 9.4 %, PPV 24 % and NPV 82 %.
Conclusion
Bilirubin levels may be high, but remain within normal range, in cases of appendicitis. Therefore, bilirubin levels may be a useful measurement when investigating a patient with suspected appendicitis. Hyperbilirubinaemia is highly specific with regards to perforation, a finding supported by other studies. However, possibly because of the few perforated cases in this study, we cannot recommend that hyperbilirubinaemia be used to predict perforation.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26038057</pmid><doi>10.1007/s00068-015-0540-x</doi><tpages>4</tpages></addata></record> |
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| ispartof | European journal of trauma and emergency surgery (Munich : 2007), 2016-04, Vol.42 (2), p.249-252 |
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| subjects | Adult Aged, 80 and over Analysis Appendectomy - methods Appendectomy - statistics & numerical data Appendicitis Appendicitis - blood Appendicitis - complications Appendicitis - diagnosis Appendicitis - etiology Appendicitis - surgery Bilirubin - blood Biomarkers - blood Child Critical Care Medicine Emergency Medicine Female Humans Hyperbilirubinemia - complications Hyperbilirubinemia - diagnosis Intensive Male Medical diagnosis Medicine Medicine & Public Health Original Article Predictive Value of Tests Preoperative Period Prognosis Retrospective Studies Risk Assessment Sports Medicine Studies Surgery Surgical Orthopedics Traumatic Surgery United Kingdom |
| title | Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation |
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