Bilirubin als diagnostischer Marker der akuten perforierten Appendizitis

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Aufrufstatistik

URI: http://hdl.handle.net/10900/76485
http://nbn-resolving.de/urn:nbn:de:bsz:21-dspace-764851
http://dx.doi.org/10.15496/publikation-17887
Dokumentart: Dissertation
Date: 2017-05-30
Source: Emerg Med J. 2015 Sep;32(9):698-702. doi: 10.1136/emermed-2013-203349. Epub 2014 Dec 4.
Language: German
Faculty: 4 Medizinische Fakultät
Department: Medizin
Advisor: Kirschniak, Andreas (PD Dr.)
Day of Oral Examination: 2017-03-30
DDC Classifikation: 610 - Medicine and health
Keywords: Blinddarmentzündung , Hyperbilirubinämie , Akutes Abdomen
License: Publishing license including print on demand
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Abstract:

BACKGROUND: Hyperbilirubinaemia is reported to be a positive predictor in diagnosing appendicitis and especially appendiceal perforation. We, therefore, analysed the diagnostic accuracy of serum bilirubin in anticipating appendicitis and its severity. METHODS: All consecutive patients undergoing appendectomy for suspected appendicitis from May 2009 to August 2011 were analysed. Patients were classified based on final histopathological findings into the groups: no appendiceal inflammation, non-perforated appendicitis and perforated appendicitis. Primary outcome was the diagnostic accuracy of serum bilirubin levels in discriminating between no appendiceal inflammation and any appendicitis (perforated and non-perforated appendicitis) and non-perforated and perforated appendicitis. RESULTS: Of 493 analysed patients, 125 (25%) had no appendiceal inflammation, 312 (64%) had non-perforated appendicitis and 56 (11%) had perforated appendicitis. The proportion of patients with bilirubin elevation (>1.1 mg/dL) was different between those with no appendiceal inflammation (14%) and any appendicitis (36%) (p<0.0001), and between non-perforated appendicitis and perforated appendicitis 48% (p=0.04). However, the positive and negative likelihood ratios (LRs) for an elevated bilirubin were poor at discriminating the groups: no appendiceal inflammation versus any appendicitis (LR+ 2.62 (95% CI 1.65 to 4.16) and LR- 0.75 (95% CI 0.67 to 0.83)) and non-perforated appendicitis versus perforated appendicitis (LR+ estimate 1.74 (95% CI 1.28 to 2.38) and LR- 0.72 (95% CI 0.55 to 0.93)). CONCLUSIONS: Hyperbilirubinaemia is present in acute appendicitis but has a low diagnostic accuracy in discriminating between any appendicitis versus no appendiceal inflammation and perforated versus non-perforated appendicitis and is, therefore, of limited value in clinical routine.

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