Preoperative Immature Granulocyte Count and Percentage for Acute Appendisitis

NCT04440150 | Completed

• 1 other identifier: 180
• Study Type: interventional
• Target: 70
• Locations: 1 country
• Sites: 1

Brief Summary

Appendectomy is the most effective treatment option for acute appendisitis, which is the most commen emergent surgical pathology. However with in time period, surgical treatment borders are narrowed. Especially in uncomplicated acute appendicitis cases, nonoperative management (NOM) with antibiotherapies becomes primary treatment option. The COVID-19 pandemic, which is caused by 2019 novel coronavirus (2019-nCoV) and we encountered in the current process, has led to the re-questioning of surgical elective and emergency cases. Serious complications and increased mortality rates of the 2019-nCoV creates a novel problems of patient selection for emergent surgery and health care workers faced with potential health problems. As the same as the other surgical procedures, in the uncomplicated acute appendisitis cases NOM become more mandantory. NOM of uncomplicated acute appendisitis doen't increase perforation risk and general practice for decreasing surgical complications in the COVID-19 pandemic period. Additionally complicated acute appendicitis accounts for 20 to 30% of the patients undergoing appendectomy and lead to increased risk of postoperative complications, delayed recovery and longer hospital stay. Therefore, early diagnosis of complicated acute appendicitis is important; however, the most appropriate and inexpensive diagnostic method to make this diagnosis has not been established yet. Although the use of imaging methods is widespread, these methods are not accessible in many rural hospitals due to the high costs and unavailability of specialists. Thus, the need for an inexpensive and effective diagnostic technique allowing to make a differential diagnosis has not been met yet. For this purpose, several inexpensive and easily accessible blood parameter tests have been proposed; including the white blood cell count, immature granulocyte (IG) percentage, C-reactive protein levels or the neutrophil-to-lymphocyte ratio. An increase in the IG count shows that the bone marrow is active. This parameter has been used as a prognostic factor in many infectious and non infectious diseases including sepsis, acute pancreatitis, and acute myocardial infarction. The Immature granulocyte (IG) fraction includes promyelocytes, myelocytes, and metamyelocytes but not band neutrophils or myeloblasts. The IG count and percentage has become an easy-to-use method, especially with the introduction of technological advances, as it can be easily determined using the results of a routine complete blood count. It is aimed to efficacy of IG count and percentage which are calculated automatically in CBC samples, to differatiate the complicated and uncomplicated acute appendicitis cases with a cheap, easily applicable and cost effective test, especially in rural areas without enough diagnostic tests in COVID-19 pandemy.

Conditions

Acute Appendicitis

Keywords

Acute Appendicitis; Complicated Acute Appandicitis; Emergent Surgery; Immature Granulocyte Count; Immature Granulocyte Percentage

Outcome Measures

Primary Outcomes (4)

• Preoperative IG count of the patients to differentiate complicated and uncomplciated acute appendicitis

  Preoperative IG count of the patients to differentiate complicated and uncomplciated acute appendicitis

  Preoperative

• Preoperative IG count for selection of medical treatment patients of noncomplicated acute appendicitis

  Preoperative IG count of the patients to select medically treatment patients of noncomplicated acute appendicitis

  Preoperative

• Preoperative IG percentage of the patients to differentiate complicated and uncomplciated acute appendicitis

  Preoperative IG percentage of the patients to differentiate complicated and uncomplciated acute appendicitis

  Preoperative

• Preoperative IG percentage for selection of medical treatment patients of noncomplicated acute appendicitis

  Preoperative IG percentage of the patients to select medically treatment patients of noncomplicated acute appendicitis

  Preoperative

Study Arms (2)

Complicated Acute Appendicitis

OTHER

The patients were assigned to the complicated acute appendicitis group (Group C) based on the preoperative imaging findings (periappendiceal abscess formation or significant periappendiceal fat tissue contamination in ultrasonography and computed tomography), intraoperative exploration findings (presence of gangrenous appendicitis, perforation or abscess formation), and pathological examination findings (acute phlegmonous appendicitis, acute gangrenous appendicitis or acute perforated appendicitis).

Procedure: Appendectomy

Uncomplicated Acute Appendicitis

OTHER

The patients were assigned to the uncomplicated acute appendicitis group (Group UC) based on the increased diameter and wall thickness of the appendix and detection of minimal contamination in the surrounding fat tissue in the imaging tests; the presence of edema and the absence of gangrene, perforation or abscess in the the exploratory surgery of appendix, and confirmation of the diagnosis of acute appendicitis by the pathological examination findings

Procedure: Appendectomy

Interventions

Appendectomy PROCEDURE

Open or Laparascopic Surgery

Complicated Acute Appendicitis; Uncomplicated Acute Appendicitis

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age \>18 years,
• Patients diagnosed as acute appenditicitis cases according to clinical (preoperative and peroperative) and preoperative laboratory findings and imaging modalities (ultrasound, computed tomography), and pathologic results
• Patients who were operated by the same surgical team of the Kahramanmaras Sutcu Imam University Hospital.

You may not qualify if:

• Patients younger than 18 years,
• Negative appendectomies according to peroperative findings and pathologic findins
• Patients whose data were not available
• Patients who were operated by the other surgical team of the Kahramanmaras Sutcu Imam University.

Sponsors & Collaborators

• Kahramanmaras Sutcu Imam University: lead

Study Sites (1)

Kahramanmaraş Sütçü İmam University

Kahramanmaraş, 46000, Turkey (Türkiye)

Location

Related Publications (20)

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• Sauneuf B, Bouffard C, Cornet E, Daubin C, Desmeulles I, Masson R, Seguin A, Valette X, Terzi N, Parienti JJ, du Cheyron D. Immature/total granulocyte ratio: a promising tool to assess the severity and the outcome of post-cardiac arrest syndrome. Resuscitation. 2014 Aug;85(8):1115-9. doi: 10.1016/j.resuscitation.2014.04.017. Epub 2014 Apr 30.

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  PMID: 28039865 BACKGROUND

MeSH Terms

Conditions

Appendicitis

Interventions

Appendectomy

Condition Hierarchy (Ancestors)

Intraabdominal Infections; Infections; Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Cecal Diseases; Intestinal Diseases

Intervention Hierarchy (Ancestors)

Digestive System Surgical Procedures; Surgical Procedures, Operative

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: DIAGNOSTIC
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor, Assistant

Model Details: Retrospective Cohort Study

Study Record Dates

• First Submitted: June 17, 2020
• First Posted: June 19, 2020
• Study Start: June 1, 2018
• Primary Completion: June 1, 2019
• Study Completion: June 1, 2019
• Last Updated: October 17, 2023

Record last verified: 2023-10

Locations

TU (1)