The Utility of Immature Granulocyte Count on the Prediction of Acute Appendicitis in the Suspected Acute Appendicitis

NCT05033249 | Completed

• 1 other identifier: 181
• Study Type: observational
• Target: 186
• Locations: 1 country
• Sites: 1

Brief Summary

Acute appendicitis is the most common cause of abdominal pain requiring surgery in the emergency department. The whole life acute appendicitis rate is 7%. Only half of the patients with acute appendicitis are presented with typical periumbilical pain following by nausea, vomiting, and the migration of pain to the right lower quadrant. The diagnosis of acute appendicitis is based on the patient's medical history, physical examination, and laboratory findings. The Alvarado scoring system (ASS), recommends discharge, observation, and surgical intervention to patients. However, such scoring systems should not be used as the only method in diagnosis. Increased imaging use in patients with suspected acute appendicitis improved the rate of correct diagnosis. American College of Radiology Appropriateness Criteria (ACR) recommends computerized tomography (CT) as the primary imaging method to confirm the diagnosis of acute appendicitis in adults. However, CT imaging has some disadvantages, such as radiation exposure, undesirable effects associated with the use of contrast agents, and increased workload in the emergency room. The count of immature granulocytes (IGC), which is an indicator of increased activation of the bone marrow, and the percentage of IG (IGP), which is the ratio of IGs to the total white blood cell count, are also has been used differentiation of complicated acute appendicitis from uncomplicated acute appendicitis, and other inflammatory pathologies. Nowadays automatic blood analyzers can easily measure the amount and percentage of IGs simultaneously in a complete blood count test with advances in technology. It is aimed to investigate the utility of IGC and IGP on the prediction of suspected acute appendicitis according to the ASS and its effect on the need for CT scanning.

Conditions

Acute Appendicitis

Keywords

Acute appendicitis; Computed Tomography; Immature granulocyte count; Immature granulocyte percentage; Alvarado Scoring System

Outcome Measures

Primary Outcomes (2)

• The utility of Immature granulocyte count on determining clinically suspected acute appendicitis cases and diminishing computed tomography need

  Automatically counted immature granulocyte count can help to determine acute appendicitis cases and diminish the need for computed tomography in patients who admitted to the emergency room and ALVARADO score between 4 - 7.

  January 2019 - July 2019

• The utility of Immature granulocyte percentage on determining clinically suspected acute appendicitis cases and diminishing computed tomography need

  Automatically calculated immature granulocyte percentage can help to determine acute appendicitis cases and diminish the need for computed tomography in patients who admitted to the emergency room and ALVARADO score between 4 - 7.

  January 2019 - July 2019

Study Arms (2)

Normal

Alvarado Score 4 - 7 Normal according to the initial computed tomographic evaluation

Diagnostic Test: Immature granulocyte count; Diagnostic Test: Immature granulocyte percentage

Patient

Alvarado Score 4 - 7 Acute appendicitis according to the initial computed tomographic evaluation

Diagnostic Test: Immature granulocyte count; Diagnostic Test: Immature granulocyte percentage

Interventions

Immature granulocyte count DIAGNOSTIC_TEST

Automatically calculated immature granulocyte count in white blood cell count

Normal; Patient

Immature granulocyte percentage DIAGNOSTIC_TEST

Automatically calculated immature granulocyte percentage in white blood cell count

Normal; Patient

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients with abdominal pain admitted to the emergency room and whose calculated ALVARADO score was between 4 and 7. According to this result computed tomographic evaluation applied to these patients.

You may qualify if:

• Age \> 18 years
• Patients complaining about abdominal pain
• Calculated ALVARADO Score 4-7
• Whose initial imaging technique was CT

You may not qualify if:

• Patients diagnosed with other imaging methods (eg, ultrasonography)
• Patients who underwent surgery without imaging modalities
• Patients who were followed by medical treatment without surgery
• Pregnant patients
• Age \<18
• Patients with incomplete medical records
• Patients with additional diseases which can affect the blood parameters (such as underlying hematologic or rheumatologic disease, laignancies, other concurrent infectious diseases)
• Patients whom were treated with granulocyte colony-stimulating factors, glucocorticoids, or other immunosuppressants that may affect inflammation markers

Sponsors & Collaborators

• Kahramanmaras Sutcu Imam University: lead
• Özlem Güler: collaborator
• Filiz Alkan Baylan: collaborator

Study Sites (1)

Kahramanmaraş Sütçü İmam University

Kahramanmaraş, 46000, Turkey (Türkiye)

Location

Related Publications (14)

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  PMID: 22204638 BACKGROUND

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  BACKGROUND

• Shuaib A, Shuaib A, Fakhra Z, Marafi B, Alsharaf K, Behbehani A. Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis. World J Emerg Med. 2017;8(4):276-280. doi: 10.5847/wjem.j.1920-8642.2017.04.005.

  PMID: 29123605 BACKGROUND

• Dal F, Cicek Y, Pekmezci S, Kocazeybek B, Tokman HB, Konukoglu D, Simsek O, Taner Z, Sirekbasan S, Uludag SS. Role of Alvarado score and biological indicators of C-reactive protein, procalicitonin and neopterin in diagnosis of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2019 May;25(3):229-237. doi: 10.5505/tjtes.2018.57362.

  PMID: 31135946 BACKGROUND

• Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka Rk MG, editor. Gastrointestinal Emergencies. In: Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill Medical; 2010

  BACKGROUND

• Rosen MP, Ding A, Blake MA, Baker ME, Cash BD, Fidler JL, Grant TH, Greene FL, Jones B, Katz DS, Lalani T, Miller FH, Small WC, Spottswood S, Sudakoff GS, Tulchinsky M, Warshauer DM, Yee J, Coley BD. ACR Appropriateness Criteria(R) right lower quadrant pain--suspected appendicitis. J Am Coll Radiol. 2011 Nov;8(11):749-55. doi: 10.1016/j.jacr.2011.07.010.

  PMID: 22051456 BACKGROUND

• Smith MP, Katz DS, Lalani T, Carucci LR, Cash BD, Kim DH, Piorkowski RJ, Small WC, Spottswood SE, Tulchinsky M, Yaghmai V, Yee J, Rosen MP. ACR Appropriateness Criteria(R) Right Lower Quadrant Pain--Suspected Appendicitis. Ultrasound Q. 2015 Jun;31(2):85-91. doi: 10.1097/RUQ.0000000000000118.

  PMID: 25364964 BACKGROUND

• Unal Y, Barlas AM. Role of increased immature granulocyte percentage in the early prediction of acute necrotizing pancreatitis. Ulus Travma Acil Cerrahi Derg. 2019 Mar;25(2):177-182. doi: 10.14744/tjtes.2019.70679.

  PMID: 30892679 BACKGROUND

• Unal Y. A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes. Ulus Travma Acil Cerrahi Derg. 2018 Sep;24(5):434-439. doi: 10.5505/tjtes.2018.91661.

  PMID: 30394497 BACKGROUND

• Bozan MB, Yazar FM, Kale IT, Yuzbasioglu MF, Boran OF, Azak Bozan A. Delta Neutrophil Index and Neutrophil-to-Lymphocyte Ratio in the Differentiation of Thyroid Malignancy and Nodular Goiter. World J Surg. 2021 Feb;45(2):507-514. doi: 10.1007/s00268-020-05822-6. Epub 2020 Oct 16.

  PMID: 33067685 BACKGROUND

• Barut O, Demirkol MK, Bilecan EB, Sahinkanat T, Resim S. The Delta Neutrophil Index is an Early Predictive Marker of Acute Pyelonephritis in Patients with Ureteral Stone. J Coll Physicians Surg Pak. 2020 Nov;30(11):1149-1154. doi: 10.29271/jcpsp.2020.11.1149.

  PMID: 33222730 BACKGROUND

• Kong T, Park YS, Lee HS, Kim S, Lee JW, You JS, Chung HS, Park I, Chung SP. The delta neutrophil index predicts development of multiple organ dysfunction syndrome and 30-day mortality in trauma patients admitted to an intensive care unit: a retrospective analysis. Sci Rep. 2018 Nov 30;8(1):17515. doi: 10.1038/s41598-018-35796-4.

  PMID: 30504778 BACKGROUND

• Shin DH, Cho YS, Cho GC, Ahn HC, Park SM, Lim SW, Oh YT, Cho JW, Park SO, Lee YH. Delta neutrophil index as an early predictor of acute appendicitis and acute complicated appendicitis in adults. World J Emerg Surg. 2017 Jul 24;12:32. doi: 10.1186/s13017-017-0140-7. eCollection 2017.

  PMID: 28747992 BACKGROUND

• Barut O, Demirkol MK, Kucukdurmaz F, Sahinkanat T, Resim S. Pre-treatment Delta Neutrophil Index as a Predictive Factor in Renal Cell Carcinoma. J Coll Physicians Surg Pak. 2021 Feb;31(2):156-161. doi: 10.29271/jcpsp.2021.02.156.

  PMID: 33645181 BACKGROUND

MeSH Terms

Conditions

Appendicitis

Condition Hierarchy (Ancestors)

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

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor, Assistant

Study Record Dates

• First Submitted: June 19, 2021
• First Posted: September 2, 2021
• Study Start: January 1, 2019
• Primary Completion: July 1, 2019
• Study Completion: July 1, 2019
• Last Updated: February 23, 2024

Record last verified: 2024-02

Locations

TU (1)