Ulus Travma Acil Cerrahi Derg. 2022; 28(12): 1716-1722 | DOI: 10.14744/tjtes.2021.86322

An effective and reliable marker in gradýng the severity of acute cholecystitis: Increased immature granulocyte percentage

Yýlmaz Ünal¹, Salih Tuncal¹, Berkay Küçük², Aziz Mutlu Barlas¹, Saygýn Altýner¹, Recep Balýk³, Seyit Murat Aydýn¹, Abdullah Senlikci¹, Mevlüt Recep Pekcici^1
1Department of General Surgery, University of Health Sciences Ankara Training and Research Hospital, Ankara-Türkiye
²Department of Intensive Care, University of Health Sciences Ankara City Hospital, Ankara-Türkiye
³Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Haydarpaþa Numune Training and Research Hospital, Ýstanbul-Türkiye

BACKGROUND: Acute cholecystitis (AC) is an acute inflammatory disease of gallbladder and it is one of the most common causes of acute abdominal pain. Determining the severity of AC at hospital admission is extremely important to choose the most effective treatment method and predict vital prognosis. The aim of this study was to investigate the effectiveness of immature granulocyte percentage (IG%) in grading AC severity.
METHODS: This retrospective study was carried out on 528 patients hospitalized due to AC diagnosis. Demographic data, white blood cell (WBC) count, neutrophil lymphocyte ratio (NLR), IG%, C-reactive protein (CRP) levels, and imaging results of patients were recorded. Furthermore, patients’ length of hospital stay was determined. Tokyo Guidelines were used to grade AC severity. According to this grading, patients were classified into three groups as grade 1 (mild), grade 2 (moderate), and grade 3 (severe) AC. Differences among groups were analyzed statistically.
RESULTS: There were 386 patients (73.1%) in the mild AC group, 102 patients (19.3%) in the moderate AC group, and 40 patients (7.6%) in the severe AC group. WBC, NLR, CRP and IG% were significant parameters in discriminating mild AC from moderate and severe AC. However, only IG% was a significant parameter in discriminating moderate AC from severe AC. Moreover, the power of IG% to discriminate between patients with mild and moderate AC and those with severe AC was dramatically higher than the other parameters.
CONCLUSION: Increased IG% is seen as an effective and reliable predictor in the early determination of AC severity.

Keywords: Acute cholecystitis, immature granulocyte percentage, inflammatory markers, severity grading; Tokyo guidelines.

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Akut kolesistitin þiddetini derecelendirmede etkili ve güvenilir bir belirteç: Artmýþ immatür granülosit yüzdesi

Yýlmaz Ünal¹, Salih Tuncal¹, Berkay Küçük², Aziz Mutlu Barlas¹, Saygýn Altýner¹, Recep Balýk³, Seyit Murat Aydýn¹, Abdullah Senlikci¹, Mevlüt Recep Pekcici^1
1Saðlýk Bilimleri Üniversitesi Týp Fakültesi, Ankara Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ankara
²Saðlýk Bilimleri Üniversitesi Týp Fakültesi, Ankara Þehir Hastanesi, Yoðun Bakým Kliniði, Ankara
³Saðlýk Bilimleri Üniversitesi Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi, Enfeksiyon Hastalýklarý ve Klinik Mikrobiyoloji Kliniði, Ýstanbul

AMAÇ: Akut kolesistit (AK) safra kesesinin akut enflamatuvar hastalýðýdýr ve akut karýn aðrýsýnýn en yaygýn sebeplerinden biridir. Hastaneye kabulde AK þiddetini belirlemek en etkili tedavi yöntemini seçmek ve hayati prognozu tahmin etmek için son derece önemlidir. Bu çalýþmanýn amacý, immatür granülosit yüzdesinin (IG%) AK þiddetini derecelendirmedeki etkinliðini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma AK tanýsýyla hastaneye yatýrýlan 528 hasta üzerinde yapýldý. Hastalarýn demografik verileri, beyaz küre sayýsý (WBC), nötrofil lenfosit oraný (NLR), IG% ve C-reaktif protein (CRP) düzeyleri ve görüntüleme bulgularý kaydedildi. Ayrýca hastalarýn hastanede kalma süreleri tespit edildi. AK þiddetini derecelendirmek için Tokyo Kýlavuzlarý kullanýldý. Bu derecelendirmeye göre hastalar grade 1 (hafif), grade 2 (orta) ve grade 3 (þiddetli) AK olarak üç gruba ayrýldý. Gruplar arasýndaki farklar istatistiksel olarak analiz edildi.
BULGULAR: Hafif AK grubunda 386 (%73.1), orta AK grubunda 102 (%19.3) ve þiddetli AK grubunda 40 (%7.6) hasta mevcuttu. Hafif AK’yý orta ve þiddetli AK’dan ayýrmada WBC, NLR, CRP ve IG% anlamlý parametreler idi. Ancak orta AK’yý þiddetli AK’dan ayýrmada sadece IG% anlamlý parametre idi. Ayrýca IG%’sinin hafif ve orta AK’lý hastalarý þiddetli hastalardan ayýrma gücü diðer parametrelerden önemli ölçüde daha yüksek idi.
TARTIÞMA: Artmýþ IG% AK þiddetinin erken tespitinde etkili ve güvenilir bir tahmin edici olarak görülmektedir.

Anahtar Kelimeler: Akut kolesistit, enflamasyon belirteçleri, immatür granülosit yüzdesi, þiddet derecelendirmesi; Tokyo Klavuzlarý.

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