C-reactive protein is superior to bilirubin for anticipation of perforation in acute appendicitis

Objective. Very recently it has been shown that hyperbilirubinemia is a specific predictor of perforation in acute appendicitis. We compared the diagnostic importance of bilirubin, C-reactive protein (CRP), leukocyte count and age as markers of perforation in acute appendicitis. Material and methods. A two-center retrospective cohort study was completed. Patients with acute appendicitis (n = 725) were divided into two groups, group A with perforation (n = 155) and group B without (n = 570). Results. In group A an elevated CRP (>5 mg/l) was measured in 98% of cases versus 72.5% in group B. Hyperbilirubinemia (>20 mu mol/l) was measured in 38% of cases in group A versus 22.3% in group B. Leukocytosis (>10 x 10(9)/l) was measured in 85% of cases in group A versus 79.3% in group B. Analysis of qualitative and quantitative data showed every marker to be significantly correlated with perforation except elevated white cell blood count. However CRP showed the strongest correlation. The logistic regression model showed CRP to be by far the most significant marker of perforation. Conclusions. Our results confirm hyperbilirubinemia to be a statistically significant marker of perforation in acute appendicitis. However, CRP is superior to bilirubin for anticipation of perforation in acute appendicitis.