Title: Evaluation of Significance of Total Bilirubin and C-Reactive Protein in Suspected Cases of Acute Appendicitis
Authors: Dr Prajwal K Rao, Dr John Joseph S. Martis
DOI: http://dx.doi.org/10.18535/jmscr/v4i10.12
Aims: To evaluate the importance of serum CRP level and Total bilirubin levels in the diagnosis of acute appendicitis, by comparing with final histopathologic diagnosis. Materials and Methods: This study was done in 100 patients admitted in Father Muller Medical College Hospital from November 2013 to November 2014. Patient with history of acute abdominal pain, in whom acute appendicitis was suspected based on detailed history and physical examination and will be posted for appendicectomy based on decision by surgeon. Serum C-Reactive Protein estimation and Total Bilirubin levels was measured preoperatively in suspected cases of appendicitis. Diagnosis was confirmed by intraoperative and histopathological findings. Operative finding and HPE of appendicectomy specimen and serum CRP and Serum Total bilirubin results will be documented and studied. Collected data will be analysed by frequency, percentage, mean, standard deviation and by sensitivity, specificity, positive predictive value, negative predictive value. Results were confirmed by chi-square test. Results: In our study, out of the 100 patients who were operated, 85 patients had appendicitis and 15 were normal according to intraoperative and histopathological findings. Present study of serum CRP and surgeon’s diagnosis reveals sensitivity - 75.29%, specificity - 93.33%, PPV - 98.46% and NPV - 40% and study of serum bilirubin and surgeon’s diagnosis reveals sensitivity - 58.82%, specificity - 93.33%, PPV - 98.03% and NPV - 73.68%. There was a statistical significance between serum CRP and acute appendicitis, & serum total bilirubin and acute appendicitis. Conclusion: In our study, serum CRP & total bilirubin levels are useful in the diagnosis of acute appendicitis and supports surgeon’s clinical diagnosis of acute appendicitis. Negative appendicectomy rate can be decreased, if appendicectomy is avoided in cases where serum CRP or Total bilirubin is negative. Serum CRP levels are reliable inflammatory markers that could be used to support the clinical diagnosis of appendicitis. Serum Total bilirubin is a marker for acute appendicitis with a good positive predictive value. Keywords: Appendicitis, CRP, Total bilirubin. 1. Williams NS, Bulstrode CJK, O’Connell PR. Bailey & Love’s SHORT PRACTICE of SURGERY. 26th ed. Boca Raton, FL: CRC Press; 2013. 2. Maingot R, Zinner M, Ashley S. Maingot's abdominal operations. New York: McGraw-Hill Medical; 2007. 3. Körner H. et al. Incidence of acute nonperforated and perforated appendicitis: Age-specific and sex-specific analysis. World J Surg. 1997; 21:313-317. 4. Wagner JM, McKinney WP, Carpenter JL. Does this patient have appendicitis? JAMA. 1996; 276:1589-1594. 5. Hardin DM Jr. Acute appendicitis: review and update. Am Fam Physician. 1999 Nov 1;60(7):2027-34. 6. Khan I, ur Rehman A. Application of alvarado scoring system in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2005 Jul-Sep;17(3):41-4. 7. Ohmann C, Yang Q, Franke C. Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. Eur J Surg. 1995 Apr;161(4):273-81. 8. Arian GM, Sohu KM, Ahmad E, Haider W, Naqi SA. Role of Alvarado score in diagnosis of acute appendicitis. Pak J Surg 2001;17:41-6. 9. Asfar S, Safar H, Khoursheed M, Dashti H, al-Bader A. Would measurement of C-reactive protein reduce the rate of negative exploration for acute appendicitis? J R Coll Surg Edinb. 2000 Feb;45(1):21-4. 10. Shakhatreh HS. The accuracy of C-reactive protein in the diagnosis of acute appendicitis compared with that of clinical diagnosis. Med Arh. 2000;54(2):109-10. 11. Chand N, Sanyal A. Sepsis-induced chol-estasis. Hepatology. 2006;45(1):230-241. 12. Roelofsen H, van der Veere CN, Ottenhoff R et al. Decreased bilirubin transport in the perfused liver of endotoxemic rats. Gastro-enterology. 1994;107(4):1,075–1,084Abstract
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