Hyperbilirubinaemia alone cannot distinguish a perforation in acute appendicitis

ANZ J Surg. 2016 Apr;86(4):255-9. doi: 10.1111/ans.12989. Epub 2015 Feb 2.

Abstract

Background: The objective of the study was to verify the accuracy of hyperbilirubinaemia as a marker for acute perforated appendicitis.

Methods: A comprehensive search of the MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS, Congress Abstracts and Grey literature from January 1969 to July 2014. We included cross-sectional and cohort studies, prospective and retrospective, which evaluated hyperbilirubinaemia level in perforated appendicitis and compared them with histological analysis of all appendectomy specimens.

Results: Eleven studies were analysed, which included 5395 patients. Pooled sensitivity was 54.6% (95% confidence interval (CI), 42.8-65.8) and specificity was 70.0% (95% CI, 54.7-81.9%) using STATA. The diagnostic odds ratio was 2.82 (95% CI, 1.38-5.72%). Summary receiver operating characteristic curves were constructed. The area under the curve was 0.65.

Conclusion: This meta-analysis showed that the value of hyperbilirubinaemia alone cannot predict acute perforated appendicitis.

Keywords: appendectomy specimens systematic review; appendiceal perforation; hyperbilirubinaemia; meta-analysis.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Appendectomy / methods
  • Appendicitis / blood*
  • Appendicitis / diagnosis
  • Appendicitis / pathology
  • Appendicitis / surgery
  • Child
  • Cohort Studies
  • Cross-Sectional Studies
  • Humans
  • Hyperbilirubinemia / blood
  • Hyperbilirubinemia / diagnosis*
  • Middle Aged
  • ROC Curve
  • Sensitivity and Specificity
  • Young Adult