Analysis of Hematologic Parameters and Serum Bilirubin Levels in Complicated and Uncomplicated Acute Appendicitis Patients

Rini Rahman, Ani Kartini, Yuyun Widaningsih, Agus Alim Abdullah




Acute appendicitis is inflammation of the vermiformis appendix due to lumen obstruction followed by bacterial infection. Acute appendicitis is classified into two types of disease, namely complicated and uncomplicated. Acute inflammation of the appendix requires immediate surgical action to prevent complications; therefore, a further laboratory test is required. This study was retrospective research which analyzed several hematologic parameters (WBC, Neutrophils, NLR, RDW, PLTMPV, PDW) and serum bilirubin levels. Data were statistically analyzed using Independent-t and Mann-Whitney test. Univariate logistic regression test was used to evaluate the correlation of hematologic parameters and significant serum bilirubin levels with the diagnosis of complicated and uncomplicated appendicitis. The cut-off value and diagnosis value were measured using Receiver Operating Characteristic (ROC) curve analysis. This study involved 173 subjects categorized into 67 complicated and 106 uncomplicated acute appendicitis patients. Whole blood count and neutrophil counts were significantly higher in complicated acute appendicitis (p <0.05). Similarly, NLR and PLT were significantly higher in complicated acute appendicitis (p <0.001), p > 0.05 was obtained in RDW-CV, MPV and PDW values. The higher serum bilirubin levels were reported in patients with complicated acute appendicitis compared to uncomplicated acute appendicitis (p <0.001). Logistic regression test results showed significant PLT parameters with p <0.001, while there was no significance of hematologic parameters such as WBC, neutrophil, NLR, RDW-CV, MPV, PDW and bilirubin levels. Area under curve results on the ROC curve showed 74.4% PLT with sensitivity and specificity of 97.17% and 40.29%, respectively. From the analysis of hematologic parameters and measurement of serum bilirubin levels, only the PLT parameter can be used as one of the parameters for the diagnosis of complicated appendicitis with high sensitivity but low specificity. It was recommended to perform prospective studies with more subjects.


Acute appendicitis, hematologic parameter, serum bilirubin

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Abdurachman SA. Apendisitis akut. Dalam: Ilmu penyakit dalam. Jilid II, Jakarta, Balai Penerbit FKUI, 2005: 177-82.

Sjamsuhidajat R, Wim de Jong. Apendiks vermiformis. Dalam: Buku ajar ilmu bedah. Ed Revisi,, Jakarta, EGC, 2008; 865.

Toktas O, Asian M. Mean platelet volume, red cell distribution width, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in the diagnosis of acute appendicitis. Eastern Journal of Medicine, 2017; 22(1): 5-9.

Tanrikulu CS, Tarinkulu Y, Sabuncuoglu MZ, Karamercan MA, Akkapulu N, et al. Mean platelet volume and red cell distribution width as a diagnostic marker in acute appendicitis. Iran Red Crescent Med Journal, 2014; 16(5): e10211.

Atas H, Kılıç MÖ, Terzioğlu SG, Saylam B. Role of hematological parameters in prediction of complicated appendicitis. Wien Klin Wochenschr. The Central Europian Journal, 2017; 129(9-10): 369-371.

Noha Boshnak, Mohamed Boshnaq, Hatem Elgohary. Evaluation of platelet indices and red cell distribution width as new biomarkers for the diagnosis of acute appendicitis. Journal of Investigative Surgery, 2017; 31(2): 121-129.

Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: Evidence-based review of the diagnostic approach in 2014. Western Journal of Emergency Medicine, 2015; 15(7): 859.

Narci H, Turk E, Karagulle E, Togan T, Karabulut K. The role of red cell distribution width in the diagnosis of acute appendicitis: a retrospective case-controlled study. World J Emerg Surg, 2013; 8(1): 46–52.

Khan Salamat. Evaluation of hyperbilirubinemia in acute inflammation of appendix: A prospective study of 45 cases. Kathmandu University Medical Journal, 2006; 4(3): 281-289.

Beltran MA, Mendez PE, Barrera RE, Contreras MA, Wilson CS, et al. Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? – a prospective study. Indian J Surg, 2009: 71: 265–272.

Chaudhary P, Kumar A, Saxena N, Biswal UC. Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study. Annals of Gastroenterology, 2013; 26: 325-331.

Sevinç MM, Kınacı E, Çakar E, Bayrak S, Özakay A, et al. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: An analysis of 3392 cases. Turkey. Ulus Travma Acil Cerrahi Derg, 2016; 22(2): 155-162.

Ulukent SC. All CBC parameters in diagnosis of acute appendicitis. Int J Clin Exp Med, 2016; 9(6): 11871-11876.

Burcharth J, Pommergaard HC, Rosenberg J, Gögenur I. Hyperbilirubinemia as a predictor for appendiceal perforation: A systematic review. Scandinavian Journal of Surgery, 2013; 102: 55–60.

Aydogan A, Akkucuk S, Arica S, Motor S, Karakus A, et al. The analysis of mean platelet volume and platelet distribution width levels in appendicitis. Indian J Surg, 2015; 77: 495–500.



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