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Emergency department evaluation of immature granulocytes for complicated acute appendicitis: a retrospective cohort

Burak Katipoğlu1, Hamdi Haluk Çalı1, İsmail Borazan1

  • 1Department of Emergency Medicine, Ankara Etlik City Hospital, Ankara-Türkiye.

Ulusal Travma Ve Acil Cerrahi Dergisi = Turkish Journal of Trauma & Emergency Surgery : TJTES
|July 7, 2026
PubMed

Insights

Immature granulocyte (IG) count and percentage (IG%) are not reliable preoperative biomarkers for distinguishing complicated acute appendicitis (CAA) from non-complicated acute appendicitis (NAA) in adults. These markers did not show clinically meaningful diagnostic value for CAA or perforation in this study.

Area of Science:

  • Medical diagnostics
  • Clinical pathology
  • Surgical outcomes

Background:

  • Preoperative identification of complicated acute appendicitis (CAA) is crucial for minimizing patient morbidity.
  • Assessing the diagnostic utility of immature granulocyte (IG) count and IG percentage (IG%) for predicting CAA and perforation in adults is important.

Purpose of the Study:

  • To evaluate the diagnostic performance of IG count and IG% in predicting complicated acute appendicitis (CAA) and perforation.
  • To compare the discriminatory power of IG markers against other inflammatory markers like the neutrophil-to-lymphocyte ratio (NLR).

Main Methods:

  • Retrospective review of 891 adult patients with histopathologically confirmed appendicitis.
  • Classification of appendicitis cases into complicated (CAA) and non-complicated (NAA).
  • Diagnostic performance assessed using ROC analysis, Youden index, and multivariable logistic regression.

Main Results:

  • The neutrophil-to-lymphocyte ratio (NLR) showed the highest area under the curve (AUC) for discriminating CAA (0.547), while IG% had an AUC of 0.519.
  • Patients with perforation had lower lymphocyte counts and higher NLR values.
  • IG% was numerically higher in complicated cases but did not reach statistical significance for predicting perforation in multivariable analysis.

Conclusions:

  • IG count and IG% lack clinically significant discriminatory power between CAA and NAA.
  • The observed non-significant association of IG% with perforation is hypothesis-generating, not confirmatory.
  • Findings do not support the use of IG count or IG% as standalone preoperative biomarkers for adult acute appendicitis, challenging previous studies.
Abstract

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