Advantages of Total Bilirubin for Predicting Malignant Obstructive Jaundice, A Combination of the Pandemic Era and Limited Resources Settings

Avit Suchitra; M. Iqbal Rivai; Juni Mitra; Irwan Abdul  Rachman; Rini Suswita; Rizqy Tansa

doi:10.3889/oamjms.2023.10961

Authors

Avit Suchitra Division of Digestive Surgery, Department of Surgery, Faculty of Medicine Andalas University, M. Djamil General Hospital, West Sumatera, Indonesia; Department of Surgery, Faculty of Medicine Andalas University, M. Djamil General Hospital, West Sumatera, Indonesia
M. Iqbal Rivai Division of Digestive Surgery, Department of Surgery, Faculty of Medicine Andalas University, M. Djamil General Hospital, West Sumatera, Indonesia; Department of Surgery, Faculty of Medicine Andalas University, M. Djamil General Hospital, West Sumatera, Indonesia
Juni Mitra Division of Digestive Surgery, Department of Surgery, Faculty of Medicine Andalas University, M. Djamil General Hospital, West Sumatera, Indonesia; Department of Surgery, Faculty of Medicine Andalas University, M. Djamil General Hospital, West Sumatera, Indonesia https://orcid.org/0000-0001-5697-841X
Irwan Abdul Rachman Division of Digestive Surgery, Department of Surgery, Faculty of Medicine Andalas University, M. Djamil General Hospital, West Sumatera, Indonesia; Department of Surgery, Faculty of Medicine Andalas University, M. Djamil General Hospital, West Sumatera, Indonesia https://orcid.org/0000-0003-3840-234X
Rini Suswita Division of Digestive Surgery, Department of Surgery, Faculty of Medicine Andalas University, M. Djamil General Hospital, West Sumatera, Indonesia; Department of Surgery, Faculty of Medicine Andalas University, M. Djamil General Hospital, West Sumatera, Indonesia
Rizqy Tansa Division of Digestive Surgery, Department of Surgery, Faculty of Medicine Andalas University, M. Djamil GDepartment of Surgery, Faculty of Medicine Andalas University, M. Djamil General Hospital, West Sumatera, Indonesia https://orcid.org/0000-0002-9103-2221

DOI:

https://doi.org/10.3889/oamjms.2023.10961

Keywords:

Malignant obstructive jaundice, Total Bilirubin, Direct Bilirubin, Pandemic Covid-19

Abstract

BACKGROUND: Hepatopancreatobiliary (HPB) cancer incidence and mortality are increasing worldwide. An initial diagnostic predictor is needed for recommending further diagnostic modalities, referral, and curative or palliative decisions. There were no studies conducted in area with limited accessibility setting of the COVID-19 pandemic, coupled with limited human resources and facilities.

AIM: We aimed to investigate the advantages of total bilirubin for predicting malignant obstructive jaundice, a combination of the pandemic era and limited resources settings.

METHODS: Data from all cholestasis jaundice patients at M. Djamil Hospital in Pandemic COVID-19 period from July 2020 to May 2022 were retrospectively collected. The data included demographics, bilirubin fraction results, and final diagnosis. Bivariate analysis for obtain demographic risk factor, and Receiver Operating Characteristics (ROC) analysis for getting bilirubin value.

RESULTS: Of a total 132 patients included, 35.6% were malignant obstructive jaundice, and Pancreatic adeno ca was the most malignant etiology (34.4%). Bivariate analysis showed a significant correlation between age and malignant etiology (p = 0,024). Direct and total Bilirubin reach the same level of Area Under Curve (AUC). Total bilirubin at the cutoff point level of 10.7 mg/dl had the most optimal results on all elements of ROC output, AUC 0.88, sensitivity 76.6%, specificity 90.1%, +LR 8.14, and -LR 0.26.

CONCLUSION: The bilirubin fraction is a good initial indicator for differentiating benign and malignant etiology (AUC 0.8–0.9) in pandemic era and resource-limited areas to improve diagnostic effectiveness and reduce referral duration.

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