Can immature granulocytes be used as a predictive new marker in the diagnosis of acute cholecystitis?

Mustafa Korkut 1 * , Cihan Bedel 1, Fatih Selvi 1, Kemal Eyvaz 2
More Detail
1 Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
2 Department of General Surgery, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 19, Issue 3, pp. 60-64.
OPEN ACCESS 962 Views 1129 Downloads
Download Full Text (PDF)


Aim: Acute cholecystitis (AC) is one of the most common acute surgical diseases in the emergency department (ED). The aim of this study was to investigate the efficacy of inflammatory parameters as immature granulocyte count (IGC) and immature granulocyte percentage (IG%) in the diagnosis of AC.
Material and methods: This retrospective and observational study consisted of patients, diagnosed with AC, who were admitted to a tertiary ED with abdominal pain between March 2019 and April 2021. The effectiveness of IGC and IG% in the diagnosis of AC was examined by comparing the results with the control group (CG).
Results: A total of 493 patients were included in the study. 270 patients were in the AC group, 223 patients were in the CG. IG% and IGC were found to be significantly higher in the AC group than in the CG (0.5 (0.32) vs. 0.4 (0.2); 0.06 (0.08) vs. 0.03 (0.03); p<0.001, p<0.001 respectively). It has been shown that IGC, at a cut-off value of 0.03, predicts the diagnosis of AC with 72.1% sensitivity and 55.5% specificity. On the other hand, IG%, at a cut-off value of 0.45, predicts the diagnosis of AC with 53.2% sensitivity and 72.7% specificity (AUC [0.717 (0.672-0.762); 0.692 (0.645-0.738)], respectively p<0.001, p<0.001).
Conclusions: In conclusion, IGC and IG% can be used as a useful inflammatory parameter in the diagnosis of AC in patients admitted to the emergency department.


Korkut M, Bedel C, Selvi F, Eyvaz K. Can immature granulocytes be used as a predictive new marker in the diagnosis of acute cholecystitis?. J CLIN MED KAZ. 2022;19(3):60-4.


  • Jain A, Mehta N, Secko M, Schechter J, Papanagnou D, Pandya S, et al. History, physical examination, laboratory testing, and emergency department ultrasonography for the diagnosis of acute cholecystitis. Acad Emerg Med. 2017;24(3):281-297.
  • Lee SJ, Park EJ, Lee KJ, Cha YS. The delta neutrophil index is an early predictive marker of severe acute cholecystitis. Dig Liver Dis. 2019;51(11):1593-1598.
  • Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D, et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020;15(1):1-26.
  • Micić D, Stanković S, Lalić N, Đukić V, Polovina S. Prognostic value of preoperative neutrophil-to-lymphocyte ratio for prediction of severe cholecystitis. J Med Biochem. 2018;37(2):121.
  • Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41-54.
  • Bedel C. Can we use neutrophil lymphocyte ratio and platelet lymphocyte ratio as a potential biomarker for acute cholecystitis? Ortadoğu Tıp Dergisi. 2019;11(4):404-408.
  • Hampson P, Dinsdale R, Wearn C, Bamford A, Bishop J, Hazeldine J, et al. Neutrophil Dysfunction, Immature Granulocytes, and Cell-free DNA are Early Biomarkers of Sepsis in Burn-injured Patients. A Prospective Observational Cohort Study. Ann Surg. 2017;265(6):1241-1249.
  • Lima LR, Cunha GS, Nogueira KS, Comar SR. Automated immature granulocyte count in patients of the intensive care unit with suspected infection. J. Bras. Patol. Med. Lab. 2019;55:267-280.
  • Bedel C, Korkut M, Selvi F. New markers in predicting the severity of acute pancreatitis in the emergency department: Immature granulocyte count and percentage. J Postgrad Med. 2021;67(1):7.
  • Bedel C, Korkut M, Selvi F, Zortuk Ö. The Immature Granulocyte Count Is a New Predictor of the 30-Day Mortality in Intracerebral Haemorrhage Patients: Preliminary Study. Indian j. neurosurg. 2021.
  • Ünal Y. A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes. Ulus Travma Acil Cerrahi Derg. 2018;24(5):434-439.
  • Bedel C, Korkut M, Avcı A, Uzun A. Immature Granulocyte Count and Percentage as New Predictors of Mortality in Patients with Upper Gastrointestinal Bleeding. Indian Journal of Critical Care Medicine: Peer-reviewed. Indian J Crit Care Med. 2020;24(9):794.
  • Güngör A, Göktuğ A, Güneylioğlu MM, Yaradılmış RM, Bodur I, Öztürk B, et al. Utility of biomarkers in predicting complicated appendicitis: can immature granulocyte percentage and C-reactive protein be used? J Postgrad Med. 2021;133(7):817-821.
  • Senthilnayagam B, Kumar T, Sukumaran J, Rao K R. Automated measurement of immature granulocytes: performance characteristics and utility in routine clinical practice. Patholog Res Int. 2012;2012.
  • Karakulak S, Narcı H, Ayrık C, Erdoğan S, Üçbilek E. The prognostic value of immature granulocyte in patients with acute pancreatitis. Am J Emerg Med. 2021;44:203-207.
  • Shekarchi B, Rafsanjani SZH, Fomani NSR, Chahardoli M. Emergency department bedside ultrasonography for diagnosis of acute cholecystitis; a diagnostic accuracy study. Emergency. 2018;6(1).
  • Graglia S, Shokoohi H, Loesche MA, Yeh DD, Haney RM, Huang CK, et al. Prospective validation of the bedside sonographic acute cholecystitis score in emergency department patients. Am J Emerg Med. 2021;42:15-19.
  • Ay S, Tanrikulu CS. Diagnostic utility of neutrophil lymphocyte ratio in acute complicated cholecystitis. Am J Emerg Med. 2021;42:15-9.
  • Barut O, Resim S. Can immature granulocyte predict the prognosis of bladder cancer? Medical Science, 2021; 25(109),723-729.