The value of immature granulocyte percentage in predicting the severity of acute cholecystitis patients admitted to the emergency department

Acute cholecystitis is one of the most common causes of acute abdominal pain. It is estimated that approximately 10% of the general population has gallstones and 20% of people with gallstones will present to the emergency department with symptoms of acute cholecystitis in their lifetime. Although the mortality rate in acute cholecystitis is generally less than 1%, this rate may exceed 10% in severe cases. There is not yet a marker that can detect severe cases at an early stage. Early diagnosis and treatment are critical for prognosis. In this study, we investigated the effect of IG% on disease severity and in-hospital mortality in patients with acute cholecystitis. This study included patients who presented to the Emergency Department of Mersin University Faculty of Medicine Hospital between 01.01.2019 and 30.06.2022 with abdominal pain and were diagnosed with acute cholecystitis using laboratory tests and imaging methods. The data were retrospectively analyzed. Patients were divided into three groups as mild, moderate and heavy/severe. Patients were also divided into two groups as living and those who died in the hospital. Demographic information (age, gender), CRP (C-Reactive Protein), lactate dehydrogenase (LDH), blood glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin at the time of emergency admission, Direct bilirubin, hematologic parameters (leukocyte counts, neutrophil counts, lymphocyte counts, platelet counts, immature granulocyte counts and immature granulocyte percentages) were recorded. Patients whose laboratory data could not be obtained, patients admitted due to chronic cholecystitis attack, patients receiving chemotherapy, immunosuppressive patients, pregnant women, patients with hematologic diseases and patients under 18 years of age were excluded from the study. Our study included 312 patients who were diagnosed with acute cholecystitis according to the diagnostic criteria in the 2018 Tokyo Guidelines. The mean age of the patients included in our study was 56.60 ± 15.80 years. Of the patients, 162 (51.9%) were male and 150 (48.1%) were female. When the patients were classified according to disease severity, 293 (93.9%) were mild/moderate and 19 (6.1%) were severe. Thirteen (4.2%) of the patients included in our study died. Immature granulocyte percentage level (IG% level) was found to be higher in patients in the severe/severe group compared to patients in the mild-moderate groups. In the ROC analysis performed to predict disease severity, when the cut-off value for IG (immature granulocyte) was >0.1 and above, sensitivity was 84.21%, specificity 77.47%, positive predictive value (PPV) 19.51% and negative predictive value (NPV) 98.70% (Area Under Curve (AUC)=0.817, p=0.0001). In the ROC analysis performed to predict in-hospital mortality, when the cut-off value for IG was >0.1 and above, sensitivity was 76.92%, specificity 75.92%, PPV 12.20% and NPV 98.70% (AUC=0.785, p=0.0002). According to the logistic regression results, it can be said that those with high IG percentage level were 9.497 times more at risk than normal (p=0.035). This study shows that IG% levels can be used to predict the severity of the disease and in-hospital mortality in patients with acute cholecystitis. Key words: Acute cholecystitis, immature granulocytes, prognosis, mortality