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Predictive value of immature granulocyte in the diagnosis of acute complicated appendicitis

Gulsum Feyza Turkes¹, Abdulkadir Unsal², Hakan Bulus²

¹Department of Medical Biochemistry, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey.

|December 21, 2022

Insights

Immature granulocyte (IG) levels are effective markers for diagnosing complicated appendicitis early. Higher IG counts indicate a higher likelihood of acute complicated appendicitis, offering a fast and cost-effective diagnostic tool.

Area of Science:

Hematology
Clinical Pathology
Surgical Emergencies

Background:

Early diagnosis and treatment of appendicitis are crucial to prevent complications.
Delayed treatment of appendicitis can lead to severe outcomes.
There is a need for rapid, inexpensive biomarkers for early appendicitis diagnosis.

Purpose of the Study:

To evaluate the effectiveness of immature granulocyte (IG) levels in diagnosing acute complicated appendicitis.
To compare the diagnostic value of IG count and percentage with other complete blood count (CBC) parameters.

Main Methods:

Retrospective cross-sectional study including 99 acute appendicitis patients and 41 controls.
Patients were categorized into acute simple appendicitis (n=65) and acute complicated appendicitis (n=34).
Demographic data, IG count/ratio, WBC, PNL, monocyte, MPV, and ferritin levels were analyzed using a Mindray BC6800 analyzer.

Main Results:

Acute complicated appendicitis showed significantly higher WBC, PNL, monocyte, IG count, and IG% compared to simple appendicitis.
ROC analysis revealed significant AUC values for IG count (0.893) and IG% (0.725) in diagnosing acute appendicitis.
IG count demonstrated a strong negative predictive value (85%) for acute appendicitis and higher positive likelihood ratio (+LR=2.1) than other CBC tests.

Conclusions:

Immature granulocyte (IG) count is a fast, cost-effective, and highly predictive marker for early diagnosis of acute complicated appendicitis.
IG count offers superior predictive value compared to other CBC tests for complicated appendicitis.
IG serves as a strong negative predictive test for acute appendicitis disease.

Read full analysis

Abstract

Introduction:

The goal in appendicitis is early diagnosis and early treatment. Complications develop as treatment is delayed. Therefore, there is a need for fast, low-cost markers that can be diagnosed earlier. The aim of this study is to show the effectiveness of immature granulocyte (IG) level in determining the complication of acute appendicitis.

Method:

In this retrospective cross-sectional study, 99 patients with acute appendicitis and 41 control groups were included in the study. Acute appendicitis patients were divided into two groups as acute simple appendicitis(n = 65) and acute complicated appendicitis(n = 34). In all groups, demographic data, immature granulocyte (IG) count(x103/μL), IG ratio (IG%), white blood cell (WBC), polymorphonuclear leukocytes (PNL), lymphocyte, monocyte, platelet, mean platelet volume (MPV), ferritin levels were recorded. The blood analyses were performed the Mindray BC6800 automated hematology analyzer using standard laboratory protocols. All statistical testing was undertaken using IBM SPSS Statistics for Mac.

Results:

Compared to the acute simple appendicitis, acute complicated appendicitis patients had significantly higher levels WBC, PNL, monocyte, IG count, and IG% (p = 0.009, p = 0047, p = 0.001, p = 0.018; respectively) while there was no significant difference in ferritin between groups (p = 0.49). In the ROC analysis, AUC value was found for IG count and IG% (0.893 and 0.725, cut-off 0.005 and 0.05; respectively) for acute appendicitis. The negative predictive value of IG for Acute Appendicitis was 85% and was the same as that of WBC. In acute complicated appendicitis, the AUC for IG and IG% was 0.796 (cut-off 0.02) and 0.693 (cut-off 0.2), respectively. Positive Likelihood Ratio (+LR; 2.1) value of IG was found higher than other complete blood count (CBC) tests.

Conclusion:

The IG count is test with fast, more predictive value than another CBC tests, and without cost in the early diagnosis of acute complicated appendicitis. It is strong negative predictive test for Acute Appendicitis disease.

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