Hyperbilirubinemia, C-reactive protein, total leucocyte counts and serum amylase as markers of gangrenous/perforated appendicitis

Authors

  • Piyush Dhaigude Department of General Surgery, SSIMS, Bhilai, Chattisgarh, India
  • Mayank Joshi Department of General Surgery, SSIMS, Bhilai, Chattisgarh, India
  • S. M. Zubair Department of General Surgery, SSIMS, Bhilai, Chattisgarh, India
  • M. D. Jawed Akther Department of General Surgery, SSIMS, Bhilai, Chattisgarh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20233557

Keywords:

Appendicitis, C-reactive protein, Perforated appendicitis, Total serum bilirubin, Serum amylase

Abstract

Background: C-reactive protein, serum amylase, total leucocyte count, and total serum bilirubin have been used as adjuncts for the diagnosis of appendicitis. This study assessed the diagnostic value of these markers in patients with suspected acute appendicitis.

Methods: CRP, serum amylase, total leucocyte count, and total serum bilirubin values among the patients who presented with acute appendicitis were compared among patients who had perforated appendix and non-perforated appendix. The diagnostic value of CRP and TSB markers as a predictor for perforation were compared in terms of sensitivity, specificity, PPVs, and NPV, and the diagnostic accuracy was assessed by AUC using receiver operating characteristic (ROC) curve analysis.

Results: The values of TSB (mean 3.52, S.D 0.54, p<0.001), CRP (mean 9.84, S.D 1.30, p<0.001), amylase (mean 68.2, S.D 26.4, p<0.001) were found to be significantly correlated with complicated appendicitis.

Conclusions: This study concludes that estimation of pre-operative values of TSB, CRP, and serum amylase as a part of routinely done blood investigations in patients with suspected appendicitis, helps the surgeon in diagnosing complicated types of appendicitis at an earlier stage, though it cannot be generalized due to the small sample size, further studies are needed to establish the conclusion of the study.

References

Emmanuel A, Murchan P, Wilson I, Balfe P. The value of hyperbilirubinemia in the diagnosis of acute appendicitis. Ann R Coll Surg Engl. 2011;93:213-7.

Soffer D, Zait S, Klausner J, Kluger Y. Peritoneal cultures and antibiotic treatment in patients with perforated appendicitis. Eur J Surg. 2001;167:214-6.

Khan S. The diagnostic value of hyperbilirubinemia and total leucocyte count in the evaluation of acute appendicitis. J Clin Diag Res. 2009;3:1647-52.

Berk PD, Wolkoff AW. Bilirubin Metabolism and Hyperbilirubinemia. In: Kasper DL, Braunwald Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, et al. Harrison‟ 's Textbook of Internal Medicine. 16th edition. Volume II. New York: McGraw Hill Medical Publishing Division. 2001;919.

Mayers WC, Ricciardi R. Liver Function. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Text Book of Surgery. The biological basis of modern surgical practice, Book-I. 11th edition. A Heart Court Asia PTE Ltd. 2001;1010.

Khan S. Evaluation of hyperbilirubinemia in acute inflammation of appendix: A prospective study of 45 cases. KUMJ. 2006;4(3)15:281-9.

Kyriakidis AV, I.alexandris E. Papoulie K, Athernesiou. CRP: Diagnostic aid in right lower quadrant abdomen pain. Ann Gastroenterol. 2010,23(4):307-10.

Khan MN, Davie E, Irshad K. The role of white cell count and C-reactive protein in the diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2004;16:17-9.

Kim HC, Yang DM, Lee CM, Jin W, Nam DH, Song JY, et al. Acute appendicitis: relationships between CT- determined severities and serum white blood cell counts and C-reactive protein levels. Br J Radiol. 2011;84(1008):1115-20.

Moon HM, Park BS, Moon DJ. Diagnostic Value of C-reactive Protein in Complicated Appendicitis. J Korean Soc Coloproctol. 2011;27(3):122-6.

Rogers F. Elevated Serum Amylase: A Review and an Analysis of Findings in 1,000 Cases of Perforated Peptic Ulcer. Annual Surg. 1960;153(2):228- 40.

Swensson EE, Maull KI. Clinical significance of elevated serum and urine amylase levels in patients with appendicitis. Am J Surg. 1981;142(6):667- 70.

Salt WB, Schenker S. Amylase- its clinical significance. A review of the literature. Medicine. 1976;55:269-89.

Rogers FA. Elevated serum amylase: a review and an analysis of findings in 1,000 cases of perforated peptic ulcer. Ann Surg. 1961;153:228-40.

Wu J-S. Serum and 24-hour urinary amylase tests in patients with acute abdominal pain. J Formosan Med Assoc. 1969;15-22.

McGeachin RL, Gleason JR, Adams MR. Amylase distribution in extrapancreatic, extra salivary tissues. Arch Biochem Biophys. 1958;75:403.

Emmanuel A, Murchan P, Wilson I, Balfe P. The value of hyperbilirubinemia in the diagnosis of acute appendicitis. Ann R Coll Surg Engl. 2011;93:213-7.

Soffer D, Zait S, Klausner J, Kluger Y. Peritoneal cultures and antibiotic treatment in patients with perforated appendicitis. Eur J Surg. 2001;167:214-6.

Khan S. The diagnostic value of hyperbilirubinemia and total leucocyte count in the evaluation of acute appendicitis. J Clin Diag Res. 2009;3:1647-52.

Berk PD, Wolkoff AW. Bilirubin Metabolism and Hyperbilirubinemia. In: Kasper DL, Braunwald Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, et al. Harrison‟ 's Textbook of Internal Medicine. 16th edition. Volume II. New York: McGraw Hill Medical Publishing Division. 2001;919.

Mayers WC, Ricciardi R. Liver Function. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Text Book of Surgery. The biological basis of modern surgical practice, Book-I. 11th edition. A Heart Court Asia PTE Ltd. 2001;1010.

Khan S. Evaluation of hyperbilirubinemia in acute inflammation of appendix: A prospective study of 45 cases. KUMJ. 2006;4(3)15:281-9.

Kyriakidis AV, I.alexandris E. Papoulie K, Athernesiou. CRP: Diagnostic aid in right lower quadrant abdomen pain. Ann Gastroenterol. 2010,23(4):307-10.

Khan MN, Davie E, Irshad K. The role of white cell count and C-reactive protein in the diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2004;16:17-9.

Kim HC, Yang DM, Lee CM, Jin W, Nam DH, Song JY, et al. Acute appendicitis: relationships between CT- determined severities and serum white blood cell counts and C-reactive protein levels. Br J Radiol. 2011;84(1008):1115-20.

Moon HM, Park BS, Moon DJ. Diagnostic Value of C-reactive Protein in Complicated Appendicitis. J Korean Soc Coloproctol. 2011;27(3):122-6.

Rogers F. Elevated Serum Amylase: A Review and an Analysis of Findings in 1,000 Cases of Perforated Peptic Ulcer. Annual Surg. 1960;153(2):228- 40.

Swensson EE, Maull KI. Clinical significance of elevated serum and urine amylase levels in patients with appendicitis. Am J Surg. 1981;142(6):667- 70.

Salt WB, Schenker S. Amylase- its clinical significance. A review of the literature. Medicine. 1976;55:269-89.

Rogers FA. Elevated serum amylase: a review and an analysis of findings in 1,000 cases of perforated peptic ulcer. Ann Surg. 1961;153:228-40.

Wu J-S. Serum and 24-hour urinary amylase tests in patients with acute abdominal pain. J Formosan Med Assoc. 1969;15-22.

McGeachin RL, Gleason JR, Adams MR. Amylase distribution in extrapancreatic, extra salivary tissues. Arch Biochem Biophys. 1958;75:403.

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Published

2023-11-21

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Original Research Articles