ETD

• appendicite
• appendicite complicata
• bilirubina
• età pediatrica

Introduction & Literature Review
Acute appendicitis (AA) is one of the most common causes of acute abdomen requiring urgent surgical intervention, and early recognition of complicated forms, such as perforation or gangrene, is crucial to reducing mortality and complications.
Literature indicates a correlation between hyperbilirubinemia and perforated appendicitis. Bilirubin has higher diagnostic specificity compared to classical inflammatory markers such as leukocytosis or C-reactive protein (CRP).
Hyperbilirubinemia appears to be associated with complicated forms of AA, particularly perforation. Several studies suggest that hyperbilirubinemia, particularly elevated direct bilirubin, may reflect endotoxemia-induced liver dysfunction and may serve as a specific marker for complicated appendicitis, including perforation and gangrene. A 2025 review found 31 studies that investigated patients with AA and reported serum bilirubin levels, and assessed the diagnostic performance of bilirubin in differentiating uncomplicated from complicated appendicitis.
Studies with pediatric populations are fewer and results do not agree.
The study by Ju et. al (2024) (N=135) analyzed risk factors for complicated appendicitis in children aged 0-3 years found non statistically significant difference in the correlation between hyperbilirubinemia p 0.351
The study by Yang et al (2019) (N= 1895) analyzed lab markers for complicated appendicitis in children aged 3-18 years and observed that bilirubin levels showed no statistically significant difference in perforated and non perforated appendicitis p=0.27
Similar study by Noh et al (2012) (N= 421) analyzed lab markers for complicated appendicitis in children aged 0-15 years and observed that bilirubin levels showed the highest specificity (74,8%), the highest among all, with p=0.002
The systematic review by Montero et al. (2023) which analyzed 8 studies found that in 6 out of 8 studies mean bilirubin levels correlated with complicated appendicitis (see above) “The DTA meta-analysis showed that the ability of STB to discriminate between complicated and uncomplicated PAA was high (AUC=0.83; 95% CI 0.79–0.86), with moderate sensitivity (Se=0.69; 95% CI 0.48–0.84) and high specificity (Sp=0.81; 95% CI 0.68–0.90). To our knowledge, no other biomarker had shown such a high discriminatory ability between complicated and uncomplicated acute appendicitis in children.”
Research Question
This research aims to investigate the correlation between hyperbilirubinemia (and PCR and neutrophilia and PAS score?) and complicated appendicitis pediatric population which underwent appendicectomy in Cisanello Hospital in the last 10 years Do increased levels of bilirubin correlate with a higher risk of complicated appendicitis in pediatric patients who underwent appendicectomy in Cisanello Hospital between January 2016 and September 2026? Methods Retrospective study of the correlation between hyperbilirubinemia (and PCR and neutrophilia and PAS score?) and complicated appendicitis pediatric population which underwent appendicectomy in Cisanello Hospital
Inclusion criteria: - male and female pediatric patients 6-18 - bilirubin levels checked - histological report available
Exclusion criteria: - comorbidities (metabolic diseases es. Hemolitic anemias, Gilbert syndrome, immunodeficency)
Potential Implications of this Work
This research may contribute to better understand the importance of bilirubinemia blood levels testing as a quick and unexpensive key element in assessing the risk of complicated appendicitis