Are the immature granulocyte count and percentage important in continue medical treatment in acute appendicitis? A prospective, randomized, and controlled study

BACKGROUND: Although appendectomy is still a curative therapy for acute appendicitis, medical treatment has come to the fore in uncomplicated cases. This study aimed to determine the importance of immature granulocyte (IG) count and percentage for the role of medical treatment success in uncomplicated acute appendicitis. METHODS: Acute appendicitis cases were prospectively registered between July 2019 and April 2020. Using ball drawing, patients were divided into two groups as medical treatment (Group M) and undergo appendectomy (Group A). Group M was divided into two subgroups as those who responded to medical treatment medically responded (MR) and failed medical treatment (MF) within 24 h of follow-up. Changes in IG count and percentage, C-reactive protein levels, neutrophil-lymphocyte ratio, and white blood cell count between initial administration and 24(th) h of follow-up were examined. RESULTS: Sixty-four patients who met the inclusion criteria were followed as 31 patients in Group A and 33 in Group M. At Subgroup MF 11 patients and Subgroup MR 22 patients were followed up. At the 24(th) h of the follow-up, the IG count and percentage were higher in the Group MF (for IG count: Between Group A and MF, p=0.002; between Group A and Group MR, p=0.111; and between Group MR and MF, p<0.001) (for IG percentage: Between Group A and MF, p=0.001; between Group A and MR, p=0.809; and between Group MF and MR, p=0.001). This decrease in the IG count and percentage suggests that the response to medical treatment was effective [for IG count: F (148.862) = 61, p≤0.001, η(2)=0.707] [for IG percentage: F (10.157) = 0.252, p≤0.001, η(2)=0.504]. CONCLUSION: IG count and percentage are effective for evaluating the success of medical treatment of uncomplicated acute appendicitis and they guide in the decision to continue medical treatment of uncomplicated acute appendicitis.