Umit OZDEMIR, Selin YILDIZ
İstanbul Kuzey Klinikleri Dergisi - 2026;13(2):171-178
OBJECTIVE: In the differential diagnosis of biliary colic and acute cholecystitis, physical examination, non-specific biochemical tests, and imaging methods are used. The aim of this study was to investigate the differential diagnostic power of NEUT-RI, NEUT-GI, RE-LYMP, and AS-LYMP parameters, which show neutrophil and lymphocyte activation, and are obtained with fluorescence flow cytometry during full blood count. METHODS: In this prospective cohort study, patients presenting with right upper quadrant pain were separated into two groups according to the diagnoses of acute cholecystitis and biliary colic. The conventional inflammatory markers and the NEUT-RI, NEUT-GI, RE-LYMP, and AS-LYMP values were compared. Receiver Operating Characteristics (ROC) Curve analysis was performed to investigate the diagnostic power of the inflammatory markers. RESULTS: In the acute cholecystitis group, C-reactive protein, white blood cells, neutrophil, monocyte, and immature granulocyte counts were higher, and the lymphocyte count was lower. The NEUT-RI and NEUT-GI values were significantly higher, and the RE-LYMP value was significantly lower in the acute cholecystitis group. The AS-LYMP values were similar in both groups. In the ROC analyses, the AUC values were 0.914 for CRP, 0.842 for WBC, 0.873 for neutrophils, and 0.823 for immature granulocyte count. A poor diagnostic performance was determined for NEUT-RI and NEUT-GI with AUC values of 0.662 and 0.612, respectively. The AUC for RE-LYMP and lymphocyte count was non-significant at <0.6. CONCLUSION: The results showed that NEUT-RI and NEUT-GI have limited diagnostic power in the differential diagnosis of acute cholecystitis from biliary colic, and RE-LYMP and AS-LYMP are insufficient diagnostically.
