Abstract
Purpose
To compare the performance for the prediction of perforated appendicitis of total bilirubin versus C-reactive protein (CRP), white blood cell count, the time period of symptoms’ evolution, and systemic inflammatory response syndrome (SIRS).
Methods
Prospective observational study, applying receiver operating characteristics curve analysis to compare the sensitivity and specificity of the tested variables.
Results
The period of symptom’s evolution was prolonged (105.2 ± 79.3 hours vs. 38.6 ± 17.5 hours), and CRP levels were higher in perforated appendicitis (176 ± 82.6 mg/l vs. 80 ± 76 mg/l). Most patients with perforated appendicitis had a SIRS score higher than 3 points. CRP (>76.7 mg/l), the time period of symptoms’ evolution (>34.5 hours), and SIRS (3 points or more), were the best cutoff values to predict perforated appendicitis.
Conclusions
Perforated appendicitis may be suspected based on CRP, SIRS and the time period of symptoms’ evolution. We do not recommend the use of total bilirubin to predict perforation in appendicitis.
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References
Temple CL, Huchcroft SA, Temple WJ (1995) The natural history of appendicitis in adults — A prospective study. Ann Surg 221:278–281
Körner H, Söndenaa K, Söreide JA, et al. (1997) Incidence of acute nonperforated and perforated appendicitis: Age-specific and sex-specific analysis. World J Surg 21: 313–317
Bickell NA, Aufses AH, Rojas M, et al. (2006) How time affects the risk of rupture in appendicitis. J Am Coll Surg 202:401–406
Kearney D, Cahill RA, O’Brien E, et al. (2008) Influence of delays on perforation risk in adults with acute appendicitis. Dis Colon Rectum 51:1823–1827
Andersson RE (2007) The natural history and traditional management of appendicitis revisited: Spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than early diagnosis. World J Surg 31:86–92
Ditillo MF, Dziura JD, Rabinovici R (2006) Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg 244:656–660
Omundsen M, Dennett E (2006) Delay to appendectomy and associated morbidity: A retrospective review. ANZ J Surg 76:153–155
Beltrán MA, Cruces KS (2008) Incisional hernia after Mc-Burney incision: Retrospective case-control study of risk factors and surgical treatment. World J Surg 32:596–601
Styrud J, Eriksson S, Granström L (1998) Treatment of perforated appendicitis: An analysis of 362 patients treated during 8 years. Dig Surg 15:683–686
Bijnen CL, van den Broek WT, Bijnen AB, et al. (2003) Implications of removing a normal appendix. Dig Surg 20: 215–221
Andersson RE, Hugander AP, Ghazi SH, et al. (1999) Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis. World J Surg 23:133–140
Körner H, Söndenaa K, Söreide JA, et al. (2000) The history is important in patients with suspected acute appendicitis. Dig Surg 17:364–369
Beltrán MA, Tapia TF, Cruces KS, et al. (2005) Sintomatología atípica en pacientes con apendicitis: Estudio prospectivo. Rev Chil Cir 57:417–423
Tzanakis NE, Efstathiou SP, Danulidis K, et al. (2005) A new approach to accurate diagnosis of acute appendicitis. World J Surg 29:1151–1156
Beltrán MA, Villar RM, Cruces KS (2006) Application of a diagnostic score for appendicitis by health-related non-physician professionals. Rev Med Chil 134:39–47
Bergeron E (2006) Clinical judgment remains of great value in the diagnosis of acute appendicitis. Can J Surg 49: 96–100
Oliak D, Yamini D, Udani VM, et al. (2000) Can perforated appendicitis be diagnosed preoperatively based on admission factors? J Gastrointest Surg 4:470–474
Lin CJ, Chen JD, Tiu CM, et al. (2005) Can ruptured appendicitis be detected preoperatively in the ED? Am J Emerg Med 23:60–66
Estrada JJ, Petrosyan M, Barnhart J, et al. (2007) Hyperbilirubinemia in appendicitis: A new predictor of perforation. J Gastrointest Surg 11:714–718
Dawes T, Burrows C (2007) Abdominal pain and jaundice: Appendiceal perforation and important differential. Emerg Med Australasia 19:276–278
Gimson AES (1987) Hepatic dysfunction during bacterial sepsis. Intensive Care Med 13:162–166
Lau WY, Teoh-Chan CH, Fan ST, et al. (1984) The bacteriology and septic complication of patients with appendicitis. Ann Surg 200:576–581
Bennion RS, Baron EJ, Thompson JE, et al. (1990) The bacteriology of gangrenous and perforated appendicitis — Revisited. Ann Surg 211:165–171
Brienza N, Dalfino L, Cinnella G, et al. (2006) Jaundice in critical illness: Promoting factors of a concealed reality. Intensive Care Med 32:267–274
Beltrán MA, Almonacid J, Vicencio A, et al. (2007) Predictive value of white blood cell count and C-reactive protein in children with appendicitis. J Pediatr Surg 42: 1208–1214
Levy MM, Fink MP, Marshall JC, et al. (2003) 2001 SCCM/ ESICM/ACCP/ATS/SIS International sepsis definition conference. Intensive Care Med 29:530–538
Albu E, Miller MM, Choi Y, et al. (1994) Diagnostic value of C-reactive protein in acute appendicitis. Dis Colon Rectum 37:49–51
Grönroos JM, Forsström JJ, Irjala K, et al. (1994) Phospholipase A 2, C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis. Clin Chem 40:1757–1760
Birchley D (2006) Patients with clinical acute appendicitis should have pre-operative full blood count and C-reactive protein assays. Ann R Coll Surg Engl 88:27–32
Yang HR, Wang YC, Chung PK, et al. (2006) Laboratory tests in patients with acute appendicitis. ANZ J Surg 76:71–74
Keskek M, Tez M, Yoldas O, et al. (2008) Receiver operating characteristic analysis of leukocyte counts in operations for suspected appendicitis. Am J Emerg Med 26:769–772
Ortega-Deballon P, Ruiz de Adana-Belbel JC, Hernández-Matías A, et al. (2008) Usefulness of laboratory data in the management of right iliac fossa pain in adults. Dis Colon Rectum 51:1093–1099
Póvoa P, Almeida E, Moreira P, et al. (1998) C-reactive protein as an indicator of sepsis. Intensive Care Med 24: 1052–1056
Póvoa P (2002) C-reactive protein: A valuable marker of sepsis. Intensive Care Med 28:235–243
Sierra R, Rello J, Bailén MA, et al. (2004) C-reactive protein used as an early indicator of infection in patients with systemic inflammatory response syndrome. Intensive Care Med 30:2038–2045
Chang YS, Min SY, Joo SH, et al. (2008) Septic thrombophlebitis of the porto-mesenteric veins as a complication of acute appendicitis. World J Gastroenterol 14: 4580–4582
Singh S, Evans TW (2006) Organ dysfunction during sepsis. Intensive Care Med 32:349–360
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Beltran, M.A., Mendez, P.E., Barrera, R.E. et al. Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study. Indian J Surg 71, 265–272 (2009). https://doi.org/10.1007/s12262-009-0074-8
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DOI: https://doi.org/10.1007/s12262-009-0074-8