{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:53:33Z","timestamp":1783338813092,"version":"3.54.6"},"reference-count":20,"publisher":"FapUNIFESP (SciELO)","issue":"5","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  OBJECTIVE: The aim of this study was to assess the diagnostic accuracy of immature granulocyte count and neutrophil-to-lymphocyte ratio in acute appendicitis against traditional markers like white blood cell count and C-reactive protein.  METHODS: A total of 169 appendicitis patients (appendicitis group) and 169 controls with nonspecific abdominal pain (control group) were compared in a retrospective case\u2013control study at a single-center tertiary hospital. The analysis included demographic and laboratory data, such as immature granulocyte count, neutrophil-to-lymphocyte ratio, white blood cell, and C-reactive protein. The diagnostic accuracy of the biomarkers was assessed using receiver operating characteristic analysis.  RESULTS: Compared to the control group, patients in the appendicitis group showed statistically significantly higher white blood cell, neutrophil, C-reactive protein, immature granulocyte count, immature granulocyte percentage, and neutrophil-to-lymphocyte ratio levels (p&lt;0.001 for all). The diagnostic accuracy was highest for C-reactive protein (area under the curve: 0.994, sensitivity and specificity: 95.9%), followed by neutrophil counts (area under the curve: 0.868) and white blood cell (area under the curve: 0.862). Good diagnostic performance was observed for immature granulocyte count (area under the curve: 0.807) and neutrophil-to-lymphocyte ratio (area under the curve: 0.829).  CONCLUSIONS: Immature granulocyte count and neutrophil-to-lymphocyte ratio show a significant elevation in acute appendicitis, proving useful additions to traditional diagnostic tests. C-reactive protein is the most reliable indicator; however, immature granulocyte and neutrophil-to-lymphocyte ratio may prove useful in ambiguous situations, potentially decreasing dependence on imaging techniques. Prospective studies are warranted to validate these findings and explore their prognostic value in complicated appendicitis.<\/jats:p>","DOI":"10.1590\/1806-9282.20242063","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T12:04:34Z","timestamp":1750075474000},"source":"Crossref","is-referenced-by-count":3,"title":["Immature granulocyte and neutrophil-to-lymphocyte ratio in acute appendicitis: new markers to strengthen diagnosis"],"prefix":"10.1590","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0773-3384","authenticated-orcid":false,"given":"Nazl\u0131 Karaku\u015f","family":"Kenan","sequence":"first","affiliation":[{"name":"Konya City Hospital,  T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8789-6705","authenticated-orcid":false,"given":"Emine","family":"Do\u011fan","sequence":"additional","affiliation":[{"name":"Konya City Hospital,  T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0630-8634","authenticated-orcid":false,"given":"Birsen","family":"Ertekin","sequence":"additional","affiliation":[{"name":"Beyhekim Training and Research Hospital,  T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8410-5552","authenticated-orcid":false,"given":"Fatih Cemal","family":"Tekin","sequence":"additional","affiliation":[{"name":"Konya City Hospital,  T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2025]]},"reference":[{"issue":"6","key":"ref1","doi-asserted-by":"crossref","first-page":"2974","DOI":"10.1007\/s00464-024-10813-y","article-title":"SAGES guideline for the diagnosis and treatment of appendicitis","volume":"38","author":"Kumar SS","year":"2024","journal-title":"Surg Endosc"},{"issue":"1","key":"ref2","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/s00268-006-0056-y","article-title":"The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis","volume":"31","author":"Andersson RE","year":"2007","journal-title":"World J Surg"},{"issue":"3","key":"ref3","article-title":"Misdiagnosis of acute appendicitis cases in the emergency room","volume":"16","author":"Mostafa R","year":"2024","journal-title":"Cureus"},{"issue":"10","key":"ref4","article-title":"The use of procalcitonin in the diagnosis of acute appendicitis: a systematic review","volume":"14","author":"Dale L","year":"2022","journal-title":"Cureus"},{"issue":"5","key":"ref5","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1309\/LT30BV9UJJV9CFHQ","article-title":"Immature granulocyte measurement using the Sysmex XE-2100. 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A prospective, randomized, and controlled study","volume":"28","author":"Bozan MB","year":"2022","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"issue":"1","key":"ref7","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.amjsurg.2019.04.018","article-title":"Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: a systematic review and meta-analysis","volume":"219","author":"Hajibandeh S","year":"2020","journal-title":"Am J Surg"},{"issue":"1","key":"ref8","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s13104-016-2335-5","article-title":"What is the normal value of the neutrophil-to-lymphocyte ratio?","volume":"10","author":"Forget P","year":"2017","journal-title":"BMC Res Notes"},{"issue":"12","key":"ref9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0279316","article-title":"Predictive value of immature granulocyte in the diagnosis of acute complicated 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