HYPERBILIRUBINEMIA AS A PREDICTOR OF COMPLICATED APPENDICITIS: A CROSS-SECTIONAL STUDY FROM A TERTIARY CARE CENTRE IN SOUTH INDIA

Abstract

Background: Early identification of gangrenous and perforated appendicitis remains a challenge despite advances in laboratory and imaging modalities. Hyperbilirubinemia has emerged as a potential biomarker for predicting complicated appendicitis.

Objective: To evaluate the diagnostic value of serum bilirubin in predicting gangrenous and perforated appendicitis and compare its performance with conventional inflammatory markers.

Methods: A hospital-based cross-sectional observational study was conducted in the Department of General Surgery, Sree Balaji Medical College and Hospital, Chennai, from July 2024 to August 2025. One hundred patients diagnosed with acute appendicitis and undergoing appendicectomy were included. Serum bilirubin, total leukocyte count (TLC), C-reactive protein (CRP), ultrasonography findings, operative findings, and histopathological reports were analyzed. Histopathology served as the reference standard for diagnosing complicated appendicitis.

Results: Among 100 patients, 68 had uncomplicated appendicitis, 18 had gangrenous appendicitis, and 14 had perforated appendicitis. Hyperbilirubinemia was observed in 42 patients. Elevated serum bilirubin was present in 77.8% of gangrenous appendicitis cases and 85.7% of perforated appendicitis cases. Serum bilirubin demonstrated a significant association with complicated appendicitis (p<0.001), outperforming TLC (p=0.041) and CRP (p=0.032). Diagnostic analysis revealed sensitivity of 81.3%, specificity of 76.5%, positive predictive value of 61.9%, negative predictive value of 89.7%, and overall accuracy of 78%. Receiver operating characteristic analysis demonstrated an area under the curve of 0.83 (95% CI: 0.74–0.92).

Conclusion: Hyperbilirubinemia is significantly associated with gangrenous and perforated appendicitis and may serve as an inexpensive and readily available adjunctive biomarker for predicting complicated disease.