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Hyperbilirubinemia in Appendicitis: A New Predictor of Perforation

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

This study examines the relationship between hyperbilirubinemia and appendicitis. It was hypothesized that an association exists between the presence of appendiceal perforation and hyperbilirubinemia. Patients with liver function tests on admission and pathologically confirmed appendicitis were included in the study. Age, duration of symptoms, temperature, white blood cell counts, systemic inflammatory response score, and bilirubin levels were independent variables in a logistic regression analysis assessing factors predicting the presence or absence of appendiceal gangrene/perforation. Elevated total bilirubin levels (>1 mg/dl) were found in 59 (38%) of 157 patients. Patients with gangrene/perforation were significantly (p = 0.004) more likely to have hyperbilirubinemia than those with acute suppurative appendicitis. No statistical differences were observed for any of the other variables. On logistic regression the only significant relationship between the presence or absence of appendiceal gangrene and perforation was the presence of hyperbilirubinemia (p = 0.031, 95% confidence interval 1.11–7.6). The odds of appendiceal perforation are three times higher (odds ratio 2.96) for patients with hyperbilirubinemia compared to those with normal bilirubin levels. Hyperbilirubinemia is frequently associated with appendicitis. Elevated bilirubin levels have a predictive potential for the diagnosis of appendiceal perforation.

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Authors and Affiliations

  1. Division of Emergency (Non-Trauma) Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California and Los Angeles County, USC Medical Center, 1200 North State Street, Room 10-850, Los Angeles, CA, 90033, USA

    Joaquin J. Estrada MD, Mikael Petrosyan MD, Jordan Barnhart, Matthew Tao, Helen Sohn MD, Shirin Towfigh MD & Rodney J. Mason MD PhD

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  1. Joaquin J. Estrada MD
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  2. Mikael Petrosyan MD
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  3. Jordan Barnhart
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  4. Matthew Tao
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  5. Helen Sohn MD
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  6. Shirin Towfigh MD
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  7. Rodney J. Mason MD PhD
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Correspondence to Rodney J. Mason MD PhD.

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Estrada, J.J., Petrosyan, M., Barnhart, J. et al. Hyperbilirubinemia in Appendicitis: A New Predictor of Perforation. J Gastrointest Surg 11, 714–718 (2007). https://doi.org/10.1007/s11605-007-0156-5

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  • DOI: https://doi.org/10.1007/s11605-007-0156-5

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