Hyperbilirubinemia and Hyponatremia in Predicting Severity of Acute AppendicitisMaking Way for New Markers

Abstract

 The study explores the use of hyperbilirubinemia (elevated bilirubin) and hyponatremia (low sodium) as predictive markers for the severity of acute appendicitis. Acute appendicitis, a common cause of emergency surgeries, can progress from mild to lifethreatening stages, including perforation and abscess formation. Accurate staging is essential, yet challenging, due to overlapping symptoms with other abdominal issues and limitations in traditional imaging methods, such as CT scans, which, though effective, have constraints like cost and radiation exposure. This has spurred interest in laboratory markers that could provide a less invasive and cost-effective alternative. Hyperbilirubinemia and hyponatremia have emerged as potential indicators for severe appendicitis, reflecting the body's inflammatory response. Elevated bilirubin may result from liver involvement triggered by endotoxins from a severely inflamed appendix, while hyponatremia can occur due to electrolyte shifts in response to inflammation. In the study, data from patients with histopathologically confirmed acute appendicitis showed that both markers were associated with complicated appendicitis cases. Specifically, higher bilirubin levels and lower sodium levels correlated significantly with perforated or gangrenous appendicitis, achieving notable diagnostic accuracy. When combined, hyperbilirubinemia and hyponatremia displayed increased sensitivity and specificity, suggesting their value as complementary to traditional diagnostic methods. This combination approach achieved a sensitivity of 81.3%, specificity of 64.7%, and an area under the curve (AUC) of 0.80, providing a reliable adjunct in assessing appendicitis severity. While these markers show promise, they should be used alongside clinical and imaging assessments, not as standalone indicators, given their nonspecificity. Further research could refine their role in diagnostics, particularly in settings where CT may not be accessible, offering an efficient tool for early identification of complicated appendicitis.