Abstract
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.