Immature granulocyte and neutrophil-to-lymphocyte ratio in acute appendicitis: new markers to strengthen diagnosis.

OBJECTIVE

The aim of this study was to assess the diagnostic accuracy of immature granulocyte count and neutrophil-to-lymphocyte ratio in acute appendicitis against traditional markers like white blood cell count and C-reactive protein.

METHODS

A total of 169 appendicitis patients (appendicitis group) and 169 controls with nonspecific abdominal pain (control group) were compared in a retrospective case-control study at a single-center tertiary hospital. The analysis included demographic and laboratory data, such as immature granulocyte count, neutrophil-to-lymphocyte ratio, white blood cell, and C-reactive protein. The diagnostic accuracy of the biomarkers was assessed using receiver operating characteristic analysis.

RESULTS

Compared to the control group, patients in the appendicitis group showed statistically significantly higher white blood cell, neutrophil, C-reactive protein, immature granulocyte count, immature granulocyte percentage, and neutrophil-to-lymphocyte ratio levels (p<0.001 for all). The diagnostic accuracy was highest for C-reactive protein (area under the curve: 0.994, sensitivity and specificity: 95.9%), followed by neutrophil counts (area under the curve: 0.868) and white blood cell (area under the curve: 0.862). Good diagnostic performance was observed for immature granulocyte count (area under the curve: 0.807) and neutrophil-to-lymphocyte ratio (area under the curve: 0.829).

CONCLUSIONS

Immature granulocyte count and neutrophil-to-lymphocyte ratio show a significant elevation in acute appendicitis, proving useful additions to traditional diagnostic tests. C-reactive protein is the most reliable indicator; however, immature granulocyte and neutrophil-to-lymphocyte ratio may prove useful in ambiguous situations, potentially decreasing dependence on imaging techniques. Prospective studies are warranted to validate these findings and explore their prognostic value in complicated appendicitis.