Apandisit Ayırıcı Tanısında İmmatür Granülosit Sayısının ve Yüzdesinin Rolü
Yıl 2023,
Cilt: 18 Sayı: 1, 140 - 144, 16.03.2023
İlknur Banlı Cesur
,
Zerrin Özçelik
,
Selçuk Matyar
,
Günay Ekberli
Öz
Amaç: Akut apandisit, çocuk cerrahisi pratiğinde en önemli ve yaygın olarak uygulanan acil cerrahilerden biridir. Çocuklarda apandisit tanısı yetişkinlere
göre daha zordur. Olgunlaşmamış granülosit yüzdesi (%IG) son zamanlarda erişkin popülasyonda inflamasyon şiddetinin saptanması için laboratuvar parametresi
olarak araştırılmaktadır. Çalışmanın amacı, pediatrik akut apandisit erken tanısında IG sayısı ve yüzde rolünün belirlenmesidir.
Gereç ve Yöntemler: Ocak 2021-Aralık 2022 tarihleri arasında karın ağrısı şikayeti ile Acil Servise başvuran ve preoperatif akut apandisit tanısı ile opere
edilen hastaların verileri hastane kayıtlarından geriye dönük olarak incelendi. 18 yaş altı, akut apandisit ön tanısı ile ameliyat edilen ve hemogramı olan
hastalar çalışmaya dahil edildi.
Bulgular: Çalışmaya 108 hasta dahil edildi. Akut apandisit grubunda 48 hasta, perfore apandisit grubunda 9 hasta ve kontrol grubunda 53 hasta vardı.
Apandisit ve kontrol grubundaki hastalarda ortalama IG %’si sırasıyla 0.31±0.37 ve 0.96±5.1 idi. Apandisit hastaları ile kontrol grubu arasında IG sayısı
ve yüzdesi açısından anlamlı fark bulunmadı. Akut ve perfore apandisit arasında IG sayısı ve IG % açısından istatistiksel olarak anlamlı fark bulunmadı.
Sonuç: IG sayısı ve IG%, herhangi bir ek fayda sağlamadı ve klinisyen için akut apandisit belirlemede kesin bir biyobelirteç değildir. Akut apandisit tanısı
için anamnez, fizik muayene ve laboratuvar testinin bir kombinasyonu altın standart olmaya devam etmektedir.
Kaynakça
- Debnath J, Kumar R, Mathur A, Sharma P, Kumar N, Shridar N et al. On the role of ultrasonography and CT scan in the diagnosis of acute appendicitis. Indian J Surg. 2015;77:221-226.
- Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemilogy of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910-925.
- Cheong LH, Emil S. Outcome of pediatric appendicitis: An international comparison of the united states and Canada. JAMA Surgery. 2014;149:50-55.
- Williams RF, Blakely ML, Fischer PE, Streck CJ, Dassinger MS, Gupta H et al. Diagnosing ruptured appendicitis preoperatively in pediatric patients. J Am Coll Surg. 2009;208(5):819-825.
- Güngör A, Göktuğ A, Güneylioğlu MM, Yaradılmış RM, Bodur İ, Öztürk B ve ark. Utility of biomarkers in predicting complicated appendicitis: can immature granulocyte percentage and C-reactive protein be used? Postgrad Med. 2021;133(7):817-821.
- Malia L, Sturm JJ, Smith SR, Brown RT, Campbell B, Chicaiza H. Predictors for acute appendicitis in children. Pediatr Emerg Care. 2021;37:962-968.
- Roehrl MH, Lantz D, Sylvester C, Wang JY. Age-dependent reference ranges for automated assessment of immature granulocytes and clinical significance in an outpatient setting. Arch Pathol Lab Med. 2011 Apr;135(4):471-477.
- Van der Geest PJ, Mohseni M, Brouwer R, Van der Hoven B, Steyerberg EW, Groeneveld AB. Immature granulocytes predict microbial infection and its adverse sequelae in the intensive care unit. J Crit Care. 2014;29(4):523-527.
- 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 (Kaunas). 2018;54(4):56.
- Mathews EK, Griffin RL, Mortellaro V, Beierle EA, Harmon CM, Chen MK et al. Utility of immature granulocyte percentage in pediatric appendicitis. J Surg Res. 2014 Jul;190(1):230-234.
- Hallan S, Asberg A, Edna TH. Additional value of biochemical tests in suspected acute appendicitis. Eur J Surg. 1997;163:533-538.
- Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB et al. Laboratory tests in patients with acute appendicitis. ANZ journal of surgery. 2006;76:71-74.
- Rodríguez-Sanjuán JC, Martín-Parra JI, Seco I, García-Castrillo L, Naranjo A. C-reactive protein and leukocyte count in the diagnosis of acute appendicitis in children. Dis Colon Rectum. 1999;42(10):1325-1329.
- Doraiswamy NV. Progress of acute appendicitis: a study in children. Br J Surg. 1978; 65:877-879.
- Adibe OO, Muensterer OJ, Georgeson KE, Harmon CM. Severity of appendicitis correlates with the pediatric appendicitis score. Pediatr Surg Int. 2011;27:655-658.
- Korkut M, Bedel C, Selvi F. Are immature granulocytes and deriva- tives early predictors of acute appendicitis and acute complicated appendicitis in adults? Formos J Surg. 2020;53:123–127.
- Ünal Y. A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes. Ulus Travma Acil Cerrahi Derg. 2018;24(5):434–439.
- Ansari-Lari MA, Kickler TS, Borowitz MJ. Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis. Am J Clin Pathol. 2003;120:795-799.
- Nigro KG, O'Riordan M, Molloy EJ, Walsh MC, Sandhaus LM. Performance of an automated immature granulocyte count as a predictor of neonatal sepsis. Am J Clin Pathol. 2005;123:618-624.
Role of Immature Granulocyte Count and Percentage in The Differential Diagnosis of Appendicitis
Yıl 2023,
Cilt: 18 Sayı: 1, 140 - 144, 16.03.2023
İlknur Banlı Cesur
,
Zerrin Özçelik
,
Selçuk Matyar
,
Günay Ekberli
Öz
Objective: Acute appendicitis is one of the most important and widely performed emergent surgery in pediatric surgery practice. Diagnosis of appendicitis
in children is more challenging compared to adults. The immature granulocyte percentage (IG%) is recently investigated laboratory parameter for detection
of inflammation severity in adult population . The aim of the study was determination of IG count and percentage role in early detection of pediatric acute
appendicitis.
Materials and Methods: The data of patients who applied to Emergency Room with the complaint of abdominal pain and who were operated with a pre-operative
diagnosis of acute appendicitis between January 2021 and December 2022 retrospectively reviewed from hospital records. Patients under 18 years,
operated due pre-operative diagnosis of acute appendicitis and who have hemogram included in the study.
Results: One hundred eight patients included in the study. Fourty-eight patients were in the acute appendicitis group, 9 patients were in the perforated
appendicitis group, and 53 patients were in the control group. The mean IG % of was 0.31±0.37 and 0.96±5.1 in appendicitis and control group patients,
respectively. No significant difference was found between appendicitis patients and control group in terms of IG number and percentage. No statistically
significant difference was found between acute and perforated appendicitis in terms of IG number and IG%.
Conclusion: IG number and IG% did not provide any additional benefit and is not a conclusive biomarker for clinician in determination of acute appendicitis.
A combination of anamnesis, physical examination and laboratory test remains gold standard for diagnosis of acute appendicitis.
Kaynakça
- Debnath J, Kumar R, Mathur A, Sharma P, Kumar N, Shridar N et al. On the role of ultrasonography and CT scan in the diagnosis of acute appendicitis. Indian J Surg. 2015;77:221-226.
- Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemilogy of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910-925.
- Cheong LH, Emil S. Outcome of pediatric appendicitis: An international comparison of the united states and Canada. JAMA Surgery. 2014;149:50-55.
- Williams RF, Blakely ML, Fischer PE, Streck CJ, Dassinger MS, Gupta H et al. Diagnosing ruptured appendicitis preoperatively in pediatric patients. J Am Coll Surg. 2009;208(5):819-825.
- Güngör A, Göktuğ A, Güneylioğlu MM, Yaradılmış RM, Bodur İ, Öztürk B ve ark. Utility of biomarkers in predicting complicated appendicitis: can immature granulocyte percentage and C-reactive protein be used? Postgrad Med. 2021;133(7):817-821.
- Malia L, Sturm JJ, Smith SR, Brown RT, Campbell B, Chicaiza H. Predictors for acute appendicitis in children. Pediatr Emerg Care. 2021;37:962-968.
- Roehrl MH, Lantz D, Sylvester C, Wang JY. Age-dependent reference ranges for automated assessment of immature granulocytes and clinical significance in an outpatient setting. Arch Pathol Lab Med. 2011 Apr;135(4):471-477.
- Van der Geest PJ, Mohseni M, Brouwer R, Van der Hoven B, Steyerberg EW, Groeneveld AB. Immature granulocytes predict microbial infection and its adverse sequelae in the intensive care unit. J Crit Care. 2014;29(4):523-527.
- 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 (Kaunas). 2018;54(4):56.
- Mathews EK, Griffin RL, Mortellaro V, Beierle EA, Harmon CM, Chen MK et al. Utility of immature granulocyte percentage in pediatric appendicitis. J Surg Res. 2014 Jul;190(1):230-234.
- Hallan S, Asberg A, Edna TH. Additional value of biochemical tests in suspected acute appendicitis. Eur J Surg. 1997;163:533-538.
- Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB et al. Laboratory tests in patients with acute appendicitis. ANZ journal of surgery. 2006;76:71-74.
- Rodríguez-Sanjuán JC, Martín-Parra JI, Seco I, García-Castrillo L, Naranjo A. C-reactive protein and leukocyte count in the diagnosis of acute appendicitis in children. Dis Colon Rectum. 1999;42(10):1325-1329.
- Doraiswamy NV. Progress of acute appendicitis: a study in children. Br J Surg. 1978; 65:877-879.
- Adibe OO, Muensterer OJ, Georgeson KE, Harmon CM. Severity of appendicitis correlates with the pediatric appendicitis score. Pediatr Surg Int. 2011;27:655-658.
- Korkut M, Bedel C, Selvi F. Are immature granulocytes and deriva- tives early predictors of acute appendicitis and acute complicated appendicitis in adults? Formos J Surg. 2020;53:123–127.
- Ünal Y. A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes. Ulus Travma Acil Cerrahi Derg. 2018;24(5):434–439.
- Ansari-Lari MA, Kickler TS, Borowitz MJ. Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis. Am J Clin Pathol. 2003;120:795-799.
- Nigro KG, O'Riordan M, Molloy EJ, Walsh MC, Sandhaus LM. Performance of an automated immature granulocyte count as a predictor of neonatal sepsis. Am J Clin Pathol. 2005;123:618-624.