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Diagnostic accuracy of hyperbilirubinaemia in anticipating appendicitis and its severity
  1. Sven Muller,
  2. Claudius Falch,
  3. Steffen Axt,
  4. Peter Wilhelm,
  5. Dirk Hein,
  6. Alfred Königsrainer,
  7. Andreas Kirschniak
  1. Working Group for Surgical Technology and Training, Clinic for Visceral, General and Transplant Surgery, Tübingen University Hospital, Tübingen, Germany
  1. Correspondence to Dr Andreas Kirschniak, Working Group for Experimental Minimally Invasive Surgery and Training, Clinic for General, Visceral and Transplant Surgery, Tübingen University Hospital, Waldhörnlestrasse 22, Tübingen 72072, Germany; akirschniak{at}


Background Hyperbilirubinaemia is reported to be a positive predictor in diagnosing appendicitis and especially appendiceal perforation. We, therefore, analysed the diagnostic accuracy of serum bilirubin in anticipating appendicitis and its severity.

Methods All consecutive patients undergoing appendectomy for suspected appendicitis from May 2009 to August 2011 were analysed. Patients were classified based on final histopathological findings into the groups: no appendiceal inflammation, non-perforated appendicitis and perforated appendicitis. Primary outcome was the diagnostic accuracy of serum bilirubin levels in discriminating between no appendiceal inflammation and any appendicitis (perforated and non-perforated appendicitis) and non-perforated and perforated appendicitis.

Results Of 493 analysed patients, 125 (25%) had no appendiceal inflammation, 312 (64%) had non-perforated appendicitis and 56 (11%) had perforated appendicitis. The proportion of patients with bilirubin elevation (>1.1 mg/dL) was different between those with no appendiceal inflammation (14%) and any appendicitis (36%) (p<0.0001), and between non-perforated appendicitis and perforated appendicitis 48% (p=0.04). However, the positive and negative likelihood ratios (LRs) for an elevated bilirubin were poor at discriminating the groups: no appendiceal inflammation versus any appendicitis (LR+ 2.62 (95% CI 1.65 to 4.16) and LR− 0.75 (95% CI 0.67 to 0.83)) and non-perforated appendicitis versus perforated appendicitis (LR+ estimate 1.74 (95% CI 1.28 to 2.38) and LR− 0.72 (95% CI 0.55 to 0.93)).

Conclusions Hyperbilirubinaemia is present in acute appendicitis but has a low diagnostic accuracy in discriminating between any appendicitis versus no appendiceal inflammation and perforated versus non-perforated appendicitis and is, therefore, of limited value in clinical routine.

Trial registration number NCT01698099.

  • abdomen
  • abdomen- non trauma, gastro-intestinal
  • diagnosis
  • general

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