Publication:

Hyperbilirubinemia as a predictive factor for appendicular perforation in acute appendicitis: a prospective observational study

Background Acute appendicitis is one of the most common surgical emergencies worldwide. Delay in diagnosis may lead to complications such as appendicular perforation. Identifying simple laboratory markers that predict perforation may assist in early intervention. Hyperbilirubinemia has been proposed as a potential indicator of complicated appendicitis. The objective was to evaluate the role of elevated serum bilirubin levels as a predictive factor for appendicular perforation in patients with acute appendicitis.

Methods This prospective observational study was conducted in the Department of General Surgery at Sher‑i‑Kashmir Institute of Medical Sciences (SKIMS), Soura and SKIMS Medical College Hospital, Bemina, Srinagar, India from March 2023 to February 2025. A total of 198 patients with clinically or radiologically diagnosed acute appendicitis were included. Serum bilirubin levels measured at admission were correlated with operative and histopathological findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and odds ratio were calculated.

Results The majority of patients belonged to the 20–30-year age group (50.5%). Males constituted 53% of the study population. Hyperbilirubinemia (>1.2 mg/dl) was observed in 74.2% of patients. Among patients with appendicular perforation, 90.2% had elevated bilirubin levels compared with 70.1% of patients with uncomplicated appendicitis. Sensitivity, specificity, positive predictive value, negative predictive value and odds ratio were 90.2%, 29.9%, 36.4%, 87.2% and 3.92 respectively.

Conclusion Hyperbilirubinemia is significantly associated with appendicular perforation in patients with acute appendicitis. Serum bilirubin estimation is a simple, inexpensive and widely available investigation that may aid in early detection of complicated appendicitis when interpreted alongside clinical findings.