THE DIAGNOSTIC VALUE OF IMMATURE GRANULOCYTE PERCENTAGE IN ACUTE APPENDICITIS PATIENTS.

Abstract

Studies have suggested that immature granulocyte percentage (IG%) levels may be an early marker of inflammation. In this study, it was tried to investigate whether there is a diagnostic value of IG% in appendicitis patients. This study was conducted retrospectively between the dates of 01.01.2018 and 01.05.2019 at Mersin University Faculty of Medicine, Department of Emergency Medicine. Patients over 18 years of age who were admitted to the emergency department and operated with the diagnosis of acute appendicitis were included in the study. The patients were classified into three groups as normal (control group), simple and complicated appendicitis. A total of 353 patients with a pre-diagnosis of appendicitis, 194 (55%) male, were included in the study. The mean age of the patients was calculated as 35.1 ± 14.0. The leukocyte parameter was found to be significant in distinguishing the disease; It was determined that the values of the patient group were higher than the values of the control group. (p values, respectively; 0.022 and 0.038). For CRP parameter; those with inflamed appendix were found to be lower than those with perforated appendicitis (p <0.001). When the neutrophil percentage parameter is examined; it was determined that patients with perforated appendicitis were higher than those with inflamed appendicitis (p <0.001). The immature granulocyte percentage (IG%) was found to have low power to distinguish disease and complications. For immature granulocyte percentage (IG%); AUC (Area under curve) was 0.505 and cut value was 0.2 while p value was 0.9128 in differentiating the disease. In distinguishing complications; AUC was 0.649 and cut value was 0.4 while p value was 0.0510. In our study, it was found that immature granulocyte percentage was statistically insignificant in distinguishing disease and complication. It was determined that the leukocyte value was significant in distinguishing the disease, and the CRP and percentage of neutrophils were statistically significant in distinguishing complications.

Keywords

• Appendicitis,
• Complicated appendicitis,
• C-reactive protein,
• White blood cell,
• immature granulocyte percentage,
• Neutrophil percentage,

References

1. 1. Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet. 2015;386(10000):1278-87.
2. 2. Craig S, Brenner B. Appendicitis: Practice essentials, backgrounds, anatomy. Medscape Jan. 2017;19.
3. 3. RE A. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91:28-37.
4. 4. Wu J-Y, Chen H-C, Lee S-H, et al. Diagnostic role of procalcitonin in patients with suspected appendicitis. World journal of surgery. 2012;36(8):1744-9.
5. 5. Lin C-J, Chen J-D, Tiu C-M, et al. Can ruptured appendicitis be detected preoperatively in the ED? The American journal of emergency medicine. 2005;23(1):60-6.
6. 6. Kafetzis DA VI, Nikolaides P, Sklavos M, Maktabi M, Spyridis G, et al. Procalcitonin as a predictor of severe appendicitis in children. Eur J Clin Microbiol Infect Dis. 2005;24:484-7.
7. 7. Gavela T, Cabeza B, Serrano A, Casado-Flores J. C-reactive protein and procalcitonin are predictors of the severity of acute appendicitis in children. Pediatric emergency care. 2012;28(5):416-9
8. 8. Giordano S, Pääkkönen M, Salminen P, Grönroos JM. Elevated serum bilirubin in assessing the likelihood of perforation in acute appendicitis: a diagnostic meta-analysis. International Journal of Surgery. 2013;11(9):795-800.

9. 9. Guraya SY, Al-Tuwaijri TA, Khairy GA, Murshid KR. Validity of leukocyte count to predict the severity of acute appendicitis. Saudi medical journal. 2005;26(12):1945-7.
10. 10. Bröker MEE VLE, Van Der Elst M, Stassen LPS, Schepers T. Discriminating Between Simple of Perforated Appendicitis. Journal of Surgical Research. 2012;176:79-83.
11. 11. Sand M TX, Bechara FG, Pala XF, Sand D, Landgrafe G, et al. A prospective bicenter study investigating the diagnostic value of procalcitonin in patients with acute appendicitis. European Surgical Research. 2009;43: 291-7.
12. 12. Ünal Y, Barlas AM. Role of increased immature granulocyte percentage in the early prediction of acute necrotizing pancreatitis. Ulus Travma Acil Cerrahi Derg. 2019;25(2):177-82.
13. 13. Huang Y, Xiao J, Cai T, et al. Immature granulocytes: a novel biomarker of acute respiratory distress syndrome in patients with acute pancreatitis. Journal of critical care. 2019;50:303-8.
14. 14. Pavare J, Grope I, Gardovska D. Assessment of Immature Granulocytes Percentage to Predict Severe Bacterial Infection in Latvian Children: An Analysis of Secondary Data. Medicina. 2018;54(4):56.
15. 15. Tan C, Huang Y, Zhang L, et al. Predictive value of immature granulocytes for persistent systemic inflammatory response syndrome in patients with acute pancreatitis: analysis of 1 973 cases. Zhonghua wei zhong bing ji jiu yi xue. 2018;30(12):1123-7.
16. 16. Daix T, Guérin E, Tavernier E, et al. Immature granulocytes: a risk factor of infection after cardiac surgery. Cytometry Part B: Clinical Cytometry. 2018;94(6):887-94.
17. 17. Prystowsky JB PC, Nagle AP. Appendicitis. Current problems in surgery 2005;42(10):694-742.
18. 18. Suat C Ulukent ISS, Kemal T Ulutas. All CBC parameters in diagnosis of acute appendicitis Int J Clin Exp Med 2016;9(6):11871-6.
19. 19. Agaithy ZK. Clinical value of total white blood cells and neutrophil counts in patients with suspected appendicitis: Retrospective study. World Journal of Emergency Surgery. 2012;7.
20. 20. Dong Hyuk Shin YSC, Gyu Chong Cho, et al. Delta neutrophil index as an early predictor of acute appendicitis and acute complicated appendicitis in adults. World Journal of Emergency Surgery. 2017;12.
21. 21. Ghimire R SA, Bohara S. Role of C-reactive Protein in Acute Appendicitis. Kathmandu Univ Med J Invest Surg. 2016;54(2):130-3.
22. 22. Amalesh T, Shankar M, Shankar R. CRP in acute appendicitis—is it a necessary investigation? International journal of surgery. 2004;2(2):88-9.
23. 23. Wu HP LC, Chang CF, et al. Predictive value of C-reactive protein at different cutoff levels in acute appendicitis. Am J Emerg Med. 2005;23(4):449-53.
24. 24. Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. Western Journal of Emergency Medicine. 2014;15(7):859.
25. 25. Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Laboratory tests in patients with acute appendicitis. ANZ journal of surgery. 2006;76(1‐2):71-4.
26. 26. Xharra S, Gashi-Luci L, Xharra K, et al. Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis. World Journal of Emergency Surgery. 2012;7(1):27.
27. 27. Andersson REH, Anders P; Ghazi, Sam H; Ravn, Hans; Offenbartl, S Karsten. Diagnostic Value of Disease History, Clinical Presentation, and Inflammatory Parameters of Appendicitis. World Journal of Surgery;. 1999;23(2):133-40.
28. 28. Senthilnayagam B, Kumar T, Sukumaran J, Rao K. Automated measurement of immature granulocytes: performance characteristics and utility in routine clinical practice. Pathology research international. 2012;2012.
29. 29. Ayres LS, Sgnaolin V, Munhoz TP. Immature granulocytes index as early marker of sepsis. International journal of laboratory hematology. 2019;41(3):392-6.
30. 30. Park JH, Byeon HJ, Lee KH, et al. Delta neutrophil index (DNI) as a novel diagnostic and prognostic marker of infection: a systematic review and meta-analysis. Inflammation Research. 2017;66(10):863-70.
31. 31. Park JS, Kim JS, Kim YJ, Kim WY. Utility of the immature granulocyte percentage for diagnosing acute appendicitis among clinically suspected appendicitis in adult. Journal of clinical laboratory analysis. 2018;32(7):e22458.