Diagnostic value of serum hyperbilirubinemia as an early important predictive factor for complicated appendicitis: Minia University Hospital experience | ||
| Minia Journal of Medical Research | ||
| Articles in Press, Accepted Manuscript, Available Online from 30 October 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/mjmr.2025.434109.2114 | ||
| Authors | ||
| Mohamed Khalaf1; Ahmed Attia2; Asaad Abdelrhman3; Ahmed Mohamed Kelany4; Michael Remon Roshdy Tawadros* 5 | ||
| 1general surgery department , faculty of medicine , minia university | ||
| 2Egypt, ElMinia university, faculty of medicine, professor of surgery . | ||
| 3Egypt, ElMinia university, faculty of medicine, surgery | ||
| 4department of surgey,faculty of medicine, minia university, minia, egypt | ||
| 5General Surgery Department,Minia university,Egypt | ||
| Abstract | ||
| Background: Acute appendicitis is common and time-critical, yet reliable differentiation between uncomplicated and complicated disease at first contact remains challenging, particularly where imaging access and senior review vary. Objective: To determine whether serum direct hyperbilirubinemia functions as an early indicator of complicated appendicitis and to clarify its role within routine preoperative assessment. Methods: We conducted a prospective study in the emergency surgery unit at Minia University Hospital, enrolling 400 consecutive patients with clinical features of acute appendicitis. Patients were classified as uncomplicated or complicated (perforated/gangrenous) using operative and histopathological criteria. Preoperative assessment included clinical evaluation and routine laboratories, with direct bilirubin measured alongside standard indices. Diagnostic performance was estimated using receiver operating characteristic analysis with area under the curve (AUC) and threshold-based accuracy. Results: Higher direct bilirubin values were associated with complicated appendicitis. Direct bilirubin showed good accuracy (AUC: 0.71, CI: 0.64–0.79, p<0.001*) with a cutoff >0.39 mg/dL yielding 72% sensitivity and 51% specificity. Interpreted with vital signs and routine laboratory markers, bilirubin added selective, adjunctive information for early risk stratification. Conclusion: Serum direct bilirubin provides a practical adjunct to early assessment of suspected appendicitis, supporting faster and more proportionate decisions—earlier escalation when overall risk is high and safe observation when it is low. Because testing is rapid, inexpensive, and universally available, integration into local diagnostic pathways is feasible, including in resource-constrained settings. | ||
| Keywords | ||
| acute appendicitis; bilirubin; complicated appendicitis prediction; Hyperbilirubinemia biomarker | ||
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