Ferudun KAYA, Serkan ADEMOĞLU
Eastern Journal of Medicine (EJM) - 2026;31(4):907-915
Preoperative identification of complicated acute appendicitis is important for surgical planning and perioperative management. This study assessed the associations of preoperative immature granulocyte count (IG#), immature granulocyte percentage (IG%), and C-reactive protein (CRP) with complicated appendicitis and their ability to discriminate complicated from uncomplicated disease. This retrospective cohort study included 100 adults who underwent appendectomy for acute appendicitis between January and December 2025. Patients were classified as having complicated appendicitis (n=22) or uncomplicated appendicitis (n=78) according to operative and histopathological findings. Group comparisons, receiver operating characteristic (ROC) curve analyses, and a parsimonious multivariable logistic regression model including IG#, CRP, age, and sex were performed. CRP [58.6 (19.3-155.6) vs. 27.0 (5.3-66.3) mg/L; p = 0.048] and IG# [0.07 (0.06-0.09) vs. 0.06 (0.04-0.08) x10³/µL; p = 0.039] were higher in complicated appendicitis, whereas IG% did not differ significantly (p = 0.209). The areas under the curve were 0.644 (95% confidence interval [CI]: 0.510-0.779) for IG#, 0.639 (95% CI: 0.505-0.773) for CRP, and 0.587 (95% CI: 0.445-0.729) for IG%. After adjustment, CRP remained independently associated with complicated appendicitis (odds ratio [OR]: 1.122 per 10 mg/L increase; 95% CI: 1.038-1.213; p = 0.004), whereas IG# did not (OR: 1.024 per 0.01 x10³/µL increase; 95% CI: 0.970-1.081; p = 0.389). Among the evaluated biomarkers, only CRP remained independently associated with complicated appendicitis after adjustment. IG# and CRP showed limited discriminatory performance and may be more suitable for clinical risk stratification alongside clinical and imaging findings than for definitive diagnosis in isolation.
