{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T12:02:55Z","timestamp":1790337775912,"version":"4.1.0"},"reference-count":19,"publisher":"Walter de Gruyter GmbH","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jbcpp-2026-0023_abs_002\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Early identification of complicated acute appendicitis remains a clinical challenge. Serum bilirubin has been proposed as a potential biomarker reflecting disease severity rather than primary diagnosis. To evaluate the diagnostic accuracy of serum bilirubin in predicting complicated acute appendicitis using histopathology as the reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jbcpp-2026-0023_abs_003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional diagnostic accuracy study was conducted among 150 adult patients undergoing appendectomy for suspected acute appendicitis at a tertiary care center. Preoperative serum bilirubin levels were recorded. Histopathological examination served as the gold standard. Diagnostic performance indices, including sensitivity, specificity, predictive values, accuracy, and receiver operating characteristic (ROC) analysis, were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jbcpp-2026-0023_abs_004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Acute appendicitis was confirmed by histopathology in 82.7\u202f% of cases, of which 11.3\u202f% were complicated. Elevated serum bilirubin (\u22651.2\u202fmg\/dL) was observed in 71.4\u202f% of complicated appendicitis cases compared to 26.4\u202f% of non-complicated cases (p=0.001). For predicting complicated appendicitis, serum bilirubin demonstrated a sensitivity of 71.4\u202f%, specificity of 73.6\u202f%, and a high negative predictive value of 95.3\u202f%. ROC analysis yielded an AUC of 0.712, indicating fair diagnostic accuracy, with an optimal cut-off of 1.15\u202fmg\/dL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jbcpp-2026-0023_abs_005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Serum bilirubin is a valuable adjunctive biomarker for predicting complicated appendicitis and effectively ruling out severe disease when levels are normal. Its integration into preoperative assessment may aid risk stratification and clinical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jbcpp-2026-0023","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T10:07:35Z","timestamp":1780394855000},"page":"409-415","source":"Crossref","is-referenced-by-count":0,"title":["Serum bilirubin as a predictor of complicated appendicitis: a diagnostic accuracy study"],"prefix":"10.1515","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5658-9234","authenticated-orcid":false,"given":"Edwin","family":"Joy","sequence":"first","affiliation":[{"name":"Amala Institute of Medical Sciences , Thrissur , Kerala , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thesneem","family":"Changanath Kader","sequence":"additional","affiliation":[{"name":"Amala Institute of Medical Sciences , Thrissur , Kerala , India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"2026092511255264129_j_jbcpp-2026-0023_ref_001","doi-asserted-by":"crossref","unstructured":"Halaseh, S, Kostalas, M, Kopec, C, Nimer, A. Bilirubin as a predictor of complicated appendicitis in a district general hospital: a retrospective analysis. Cureus 2022;14. https:\/\/doi.org\/10.7759\/cureus.29036.","DOI":"10.7759\/cureus.29036"},{"key":"2026092511255264129_j_jbcpp-2026-0023_ref_002","doi-asserted-by":"crossref","unstructured":"Dubey, VK, Singh, S, Jauhari, RK, Mishra, Y, Sijwali, K. A prospective study on significance of blood markers (total serum bilirubin, pro-calcitonin, C-Reactive protein) in predicting complicated appendicitis. Indian J Appl Res 2025;15. https:\/\/doi.org\/10.36106\/ijar\/4901024.","DOI":"10.36106\/ijar\/4901024"},{"key":"2026092511255264129_j_jbcpp-2026-0023_ref_003","doi-asserted-by":"crossref","unstructured":"Dalai, P, Nayak, J, Kumar, T, Sahoo, I, Behera, A, Das, P. Serum bilirubin as a new diagnostic marker for appendicitis and appendicular Perforation\u00a0\u2013\u00a0A case series analysis. Indian J Surg 2023;85:1362\u20135. https:\/\/doi.org\/10.1007\/s12262-023-03748-6.","DOI":"10.1007\/s12262-023-03748-6"},{"key":"2026092511255264129_j_jbcpp-2026-0023_ref_004","doi-asserted-by":"crossref","unstructured":"Bhandari, S, Baral, A, Tiwari, A, Shrestha, SK. The role of high serum bilirubin as a predictor of complicated appendicitis: a retrospective cohort study. IJS Glob Heal 2023;6. https:\/\/doi.org\/10.1097\/gh9.0000000000000359.","DOI":"10.1097\/GH9.0000000000000359"},{"key":"2026092511255264129_j_jbcpp-2026-0023_ref_005","doi-asserted-by":"crossref","unstructured":"Bakshi, S, Mandal, N. Evaluation of role of hyperbilirubinemia as a new diagnostic marker of complicated appendicitis. BMC Gastroenterol 2020;21. https:\/\/doi.org\/10.1186\/s12876-021-01614-x.","DOI":"10.21203\/rs.2.21496\/v5"},{"key":"2026092511255264129_j_jbcpp-2026-0023_ref_006","doi-asserted-by":"crossref","unstructured":"Shuaib, A, Alhamdan, N, Arian, H, Sallam, M, Shuaib, A. 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Validity of serum total bilirubin as a diagnostic tool for acute appendicitis. Int J Surg Med 2017;3:216. https:\/\/doi.org\/10.5455\/ijsm.serum-total-bilirubin-as-a-diagnostic-tool-for-acute-appendicitis.","DOI":"10.5455\/ijsm.serum-total-bilirubin-as-a-diagnostic-tool-for-acute-appendicitis"},{"key":"2026092511255264129_j_jbcpp-2026-0023_ref_017","doi-asserted-by":"crossref","unstructured":"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;8:46. https:\/\/doi.org\/10.1186\/1749-7922-8-46.","DOI":"10.1186\/1749-7922-8-46"},{"key":"2026092511255264129_j_jbcpp-2026-0023_ref_018","doi-asserted-by":"crossref","unstructured":"Hong, YR, Chung, C-W, Kim, JW, Kwon, CI, Ahn, DH, Kwon, SW, et al.. Hyperbilirubinemia is a significant indicator for the severity of acute appendicitis. 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