Hyperbilirubinemia and elevated C-reactive protein as predictive markers for appendiceal perforation in acute appendicitis:  A prospective observational study: Predictive markers for appendiceal perforation in acute appendicitis

Sai Trinadh Gunda; Arulvanan Nandan

doi:10.28982/josam.8376

Authors

Sai Trinadh Gunda Department of General Surgery, Fortis Hospital, Mulund, Mumbai, Maharashtra, India https://orcid.org/0009-0004-8892-2444
Arulvanan Nandan Department of General Surgery, Fortis Hospital, Mulund, Mumbai, Maharashtra, India https://orcid.org/0009-0008-2107-1082

DOI:

https://doi.org/10.28982/josam.8376

Keywords:

Hyperbilirubinemia, C-Reactive Protein, Predictive Biomarkers, appendicitis, appendicular perforation

Abstract

Background/Aim: Appendiceal perforation is a serious complication of acute appendicitis and contributes substantially to postoperative morbidity and prolonged hospital stay. Although imaging supports diagnosis, access may be limited in resource-constrained settings. This study evaluated the diagnostic utility of hyperbilirubinemia and elevated C-reactive protein (CRP) as cost-effective and readily available biomarkers for predicting appendiceal perforation.

Methods: This prospective observational study was conducted at Fortis Hospital, Mulund, Mumbai, from July 2023 to December 2024. Fifty adult patients with acute appendicitis who provided informed consent and underwent surgical management were included. Patients with liver disease, hepatobiliary malignancy, chronic alcoholism, hemolytic anemia, pregnancy, conservative treatment, or medications causing cholestasis were excluded. Preoperative serum bilirubin and CRP levels were measured and correlated with intraoperative and histopathological findings.

Results: The mean age of the 50 enrolled patients was 31.94 (14.12) years, 30 (60%) were male, and 15 (30%) had perforated appendicitis. The mean serum bilirubin level was 1.42 (0.19) mg/dL in the perforation group and 1.06 (0.21) mg/dL in the non-perforation group (P < 0.001). The mean CRP level was significantly higher in the perforation group than in the non-perforation group [243.3 (45.9) mg/L vs. 135.8 (51.3) mg/L; P < 0.001]. Receiver operating characteristic curve analysis showed strong diagnostic performance, with an area under the curve of 0.90 for bilirubin and 0.92 for CRP.

Conclusion: Elevated serum bilirubin and CRP levels are reliable non-invasive markers for predicting perforated appendicitis and may be particularly valuable in settings where advanced imaging is unavailable.

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