Clinical Implications of Serum Bilirubin and Procalcitonin in the Diagnosis of Acute Appendicitis

Cikuru Rodrigue Buhendwa1, Edyedu Isaac1, Idania Hidalgo2 and *Emmanuel Ifeanyi Obeagu3

1Department of General Surgery, Kampala International University, Uganda.

2Department of Clinical Pathology, Kampala International University, Uganda.

3Department of Medical Laboratory Science, Kampala International University, Uganda.

*Corresponding author: Emmanuel Ifeanyi Obeagu, Department of Medical Laboratory Science, Kampala International University, Uganda.

E-mail:,, 0000-0002-4538-0161


Acute appendicitis remains a common surgical emergency with challenges in prompt and accurate diagnosis. Serum biomarkers have garnered attention for their potential role in aiding diagnostic accuracy. This paper aims to update the clinical implications of serum bilirubin and procalcitonin levels in diagnosing acute appendicitis. A systematic review of literature was conducted, encompassing studies that investigated the relationship between serum bilirubin and procalcitonin levels and acute appendicitis. The search strategy included electronic databases, resulting in a comprehensive analysis of relevant articles. The findings suggest a notable association between elevated serum bilirubin levels and the presence of acute appendicitis. Furthermore, procalcitonin exhibited promising diagnostic potential, demonstrating a significant correlation with the severity of appendicitis. Subgroup analyses revealed varied sensitivity and specificity values, indicating the need for further refinement in clinical application. The integration of serum biomarkers, specifically bilirubin and procalcitonin, into the diagnostic algorithms of acute appendicitis could potentially enhance the accuracy of clinical assessments. However, limitations in existing studies, such as heterogeneity in patient populations and differing assay methodologies, emphasize the necessity for standardized protocols and larger prospective trials. In conclusion, serum bilirubin and procalcitonin levels show promise as adjunctive tools in diagnosing acute appendicitis. Their incorporation into clinical practice warrants careful consideration and validation through larger-scale studies to delineate their precise diagnostic utility, thereby potentially optimizing patient care pathways in the context of this prevalent surgical condition.

Keywords : Acute appendicitis, Bilirubin, Procalcitonin, Diagnosis, Clinical implications


Acute appendicitis represents one of the most common surgical emergencies worldwide, necessitating prompt diagnosis and intervention to prevent potentially severe complications. Despite advancements in diagnostic imaging modalities and clinical evaluation, accurately discerning appendicitis at its early stages remains a challenge. Consequently, there exists a continuous quest for reliable and efficient diagnostic tools to aid clinicians in timely decision-making and appropriate management [1]. In recent years, the exploration of serum biomarkers has emerged as a promising avenue for improving the diagnostic accuracy of acute appendicitis. Among these biomarkers, serum bilirubin and procalcitonin have garnered substantial interest due to their potential role in reflecting inflammatory and infectious processes, respectively, within the appendiceal microenvironment [2]. The significance of serum bilirubin lies not only in its established role as a marker of hepatic function but also in its suggested association with inflammatory conditions, including appendicitis. Elevated bilirubin levels have been hypothesized to correlate with the severity and progression of inflammatory processes within the appendiceal tissue, prompting investigations into its potential utility as a diagnostic indicator in acute appendicitis [3]. Similarly, procalcitonin, a precursor of the hormone calcitonin, has gained recognition as a marker of bacterial infections. Elevated levels of procalcitonin have been observed in various systemic infections, and recent studies have explored its potential relevance in identifying the presence and severity of bacterial-induced inflammation in appendicitis [4]. This paper aims to critically evaluate the clinical implications of serum bilirubin and procalcitonin levels in the diagnosis of acute appendicitis. By synthesizing and analyzing available literature, this study seeks to elucidate the potential roles of these serum biomarkers, individually and in combination, in augmenting the accuracy and efficiency of diagnosing acute appendicitis. Additionally, it aims to address existing gaps in research, emphasize the strengths and limitations of current evidence, and propose directions for future investigations to enhance diagnostic strategies in this critical surgical condition.


The evaluation of serum biomarkers, particularly serum bilirubin and procalcitonin, in the diagnosis of acute appendicitis represents a significant stride towards enhancing diagnostic precision and refining clinical decision-making in this prevalent surgical condition. The synthesis of existing literature suggests a potential association between elevated serum bilirubin levels and the presence of acute appendicitis. Similarly, procalcitonin has exhibited promise as a marker correlating with the severity of bacterial-induced inflammation in appendicitis. These findings underscore the potential clinical utility of these serum biomarkers in aiding the diagnostic process. The integration of serum bilirubin and procalcitonin levels into the diagnostic armamentarium for acute appendicitis holds substantial promise. By augmenting traditional clinical assessments and imaging studies, these biomarkers have the potential to refine diagnostic accuracy, assist in risk stratification, and guide appropriate management strategies. Moving forward, future research endeavors should focus on refining cutoff values, establishing standardized protocols for serum biomarker use, and conducting rigorous prospective studies in diverse patient cohorts. Such efforts will be instrumental in elucidating the precise diagnostic roles of serum bilirubin and procalcitonin, paving the way for their seamless integration into routine clinical practice. While further investigations are warranted, the exploration of serum biomarkers offers exciting prospects in improving diagnostic precision and patient care strategies for acute appendicitis. Their potential to expedite diagnosis, aid risk stratification, and optimize treatment pathways underscores their value as adjunctive tools in the clinical armamentarium for this common surgical emergency.


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CITE AS: Cikuru Rodrigue Buhendwa, Edyedu Isaac, Idania Hidalgo and Emmanuel Ifeanyi Obeagu (2024). Clinical Implications of Serum Bilirubin and Procalcitonin in the Diagnosis of Acute Appendicitis. IDOSR JOURNAL OF APPLIED SCIENCES 9(1)34-39.