A PROSPECTIVE CROSS-SECTIONAL STUDY OF HYPERBILIRUBINEMIA AS A PREDICTOR OF SEVERITY OF ACUTE APPENDICITIS

Abstract

Early identification of severe acute appendicitis remains challenging despite advances in clinical assessment and imaging. Hyperbilirubinemia has appeared as a probable biochemical marker for forecasting disease severity and may assist in making decisions prior to surgery. To evaluate the correlation between the RIPASA score and serum bilirubin as a predictor of the severity of acute appendicitis. This prospective cross-sectional study comprised 77 patients with acute appendicitis confirmed by histology. RIPASA severity, appendiceal perforation, and histological results were all linked with preoperative blood total, direct, and indirect bilirubin levels. Mann-Whitney U, Chi-square, Pearson correlation, Kruskal-Wallis, and receiver operating characteristic (ROC) curve analyses were among the statistical tests used. While direct and indirect bilirubin fractions did not substantially correlate with illness severity, total blood bilirubin did demonstrate a significant correlation with increasing RIPASA severity (p = 0.004). Hyperbilirubinemia was not significantly associated with appendiceal perforation, and ROC analysis demonstrated limited predictive performance for perforation. Total bilirubin showed better discriminatory ability than direct and indirect bilirubin but was not an independent predictor. A straightforward, affordable, and easily accessible supplementary biomarker for determining the severity of acute appendicitis is serum total bilirubin. However, rather than being employed as a stand-alone predictor of appendiceal perforation, it should be evaluated in conjunction with clinical evaluation and the RIPASA score.