Diagnostic value of dry lips in patients with suspected acute appendicitis: A prospective cohort study

Abstract

Background/Aim: Acute appendicitis is a common surgical emergency, but accurate diagnosis remains challenging. Simple bedside findings may complement established diagnostic strategies. This study aimed to evaluate the diagnostic accuracy of dry lips as a bedside clinical sign in adults presenting with suspected acute appendicitis. Methods: This prospective observational cohort study was conducted in the emergency department of a tertiary care hospital from June 2024 to May 2025. Consecutive adults presenting with suspected acute appendicitis were enrolled. Dry lips were assessed during the initial examination before intravenous fluid administration, laboratory testing, or imaging. Histopathological examination confirmed appendicitis in operated patients, whereas non-operated patients were classified as not having appendicitis based on negative computed tomography findings and/or an uneventful 30-day clinical follow-up. Sensitivity, specificity, predictive values, likelihood ratios, and 95% confidence intervals (CIs) were calculated. Results: Of 115 patients screened, 96 met the eligibility criteria and were included. Acute appendicitis was confirmed in 44 patients (45.8%), and dry lips were present in 36 (37.5%). Dry lips had a sensitivity of 54.6% (95% CI, 38.8-69.6%) and a specificity of 76.9% (95% CI, 63.2-87.5%). The positive likelihood ratio was 2.36 (95% CI, 1.34-4.16), and the negative likelihood ratio was 0.59 (95% CI, 0.41-0.84). Combining dry lips with a C-reactive protein level of at least 10 mg/L increased specificity to 93.9% (95% CI, 84.4-98.0%) and the positive likelihood ratio to 6.61 (95% CI, 2.24-22.49). Conclusion: Dry lips showed moderate specificity but limited sensitivity for diagnosing acute appendicitis. This finding is not sufficiently accurate for use as a standalone test but may provide a rapid, cost-free adjunct to bedside assessment when interpreted with inflammatory markers and other clinical findings. Larger multicenter studies are needed to validate these results.