Kenan Nazlı Karakuş, Doğan Emine, Ertekin Birsen, Tekin Fatih Cemal
Konya City Hospital, Department of Emergency Medicine - Konya, Türkiye.
Beyhekim Training and Research Hospital, Department of Emergency Medicine - Konya, Türkiye.
Rev Assoc Med Bras (1992). 2025 Jun 16;71(5):e20242063. doi: 10.1590/1806-9282.20242063. eCollection 2025.
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.
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.
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).
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.
本研究旨在评估未成熟粒细胞计数和中性粒细胞与淋巴细胞比值在急性阑尾炎诊断中的准确性，并与白细胞计数和C反应蛋白等传统标志物进行对比。
在一家单中心三级医院开展的一项回顾性病例对照研究中，对169例阑尾炎患者（阑尾炎组）和169例非特异性腹痛对照者（对照组）进行了比较。分析内容包括人口统计学和实验室数据，如未成熟粒细胞计数、中性粒细胞与淋巴细胞比值、白细胞和C反应蛋白。使用受试者工作特征分析评估生物标志物的诊断准确性。
与对照组相比，阑尾炎组患者的白细胞、中性粒细胞、C反应蛋白、未成熟粒细胞计数、未成熟粒细胞百分比和中性粒细胞与淋巴细胞比值水平在统计学上显著更高（所有p<0.001）。C反应蛋白的诊断准确性最高（曲线下面积：0.994，敏感性和特异性：95.9%），其次是中性粒细胞计数（曲线下面积：0.868）和白细胞（曲线下面积：0.862）。未成熟粒细胞计数（曲线下面积：0.807）和中性粒细胞与淋巴细胞比值（曲线下面积：0.829）显示出良好的诊断性能。
未成熟粒细胞计数和中性粒细胞与淋巴细胞比值在急性阑尾炎中显著升高，是传统诊断测试的有益补充。C反应蛋白是最可靠的指标；然而，未成熟粒细胞和中性粒细胞与淋巴细胞比值在情况不明确时可能有用，有可能减少对成像技术的依赖。有必要进行前瞻性研究以验证这些发现，并探索它们在复杂性阑尾炎中的预后价值。
