Predictive efficacy of immature granulocytes in acute complicated appendicitis

Acute appendicitis is the most common cause of acute abdomen. It is important to differentiate between complicated and uncomplicated appendicitis before surgery in the emergency department. Recently, immature granulocytes have become one of the biomarkers used as predictors of inflammation. The aim of this study was to determine whether immature granulocyte levels are a biomarker that can predict whether acute appendicitis is complicated or not in patients admitted to the emergency department.

Patients aged 18 years and older who presented to the emergency department between May 1, 2023, and April 30, 2024, and were diagnosed with appendicitis were included in the study. Patients with a histopathologic diagnosis of acute appendicitis were divided into two groups: acute simple appendicitis (n=149) and acute complicated appendicitis (n=103). Demographic characteristics, imaging results, and laboratory results were recorded.

White blood cell, neutrophil count and percentage, lymphocyte count and percentage, immature granulocyte count and percentage, direct bilirubin, C-reactive protein, and procalcitonin values were found to be significantly higher in the complicated appendicitis group than in the uncomplicated group (p-values; 0.001, <0.001, <0.001, <0.001, 0.001, <0.001, <0.001, <0.001, <0.001, 0.016, <0.001, and 0.001, respectively). The immature granulocyte percentage was 92% specific for the diagnosis of complicated appendicitis at a cut-off value of 0.6.

The immature granulocyte percentage may be useful as a predictive biomarker in the diagnosis of complicated acute appendicitis with a specificity of 92%. Additionally, the immature granulocyte percentage has a higher discrimination power than the immature granulocyte count, C-reactive protein, and procalcitonin.