This retrospective study investigated preoperative markers of appendix perforation in 351 acute
appendicitis cases: group 1,
appendicitis not histologically confirmed; group 2,
appendicitis without perforation or gangrenous changes; and group 3, histologically confirmed
perforated appendicitis with gangrenous changes. In group 3, symptom duration was significantly longer, and white blood cell (WBC) and
bilirubin values significantly higher, than for the other groups. Symptom duration, gender,
bilirubin and elevated WBC were significantly associated with early diagnosis of acute
appendicitis in univariate analysis. Multivariate analysis identified increased WBC counts and male gender as independent variables for the early diagnosis of acute suppurative
appendicitis, and symptom duration, total
bilirubin and elevated WBC as independent variables for identifying appendix perforation amongst acute suppurative
appendicitis patients. Receiver operating characteristic curve analysis showed good discrimination of
bilirubin and moderate discrimination of WBC as markers of appendix perforation. It is concluded that assessment of preoperative total
bilirubin is useful for the differential diagnosis of perforated versus acute suppurative
appendicitis, whereas WBC assessment is effective for diagnosing the presence versus absence of
appendicitis. Symptom duration, WBC and total
bilirubin should be used as independent parameters in the early diagnosis of appendix perforation.