The Diagnostic Role of Immature Granulocyte in Differentiating Acute Calculous Cholecystitis From Biliary Colic

Objective: Acute biliary cholecystitis (ABC) is a significant cause of abdominal pain in emergency department. In this study, we investigated the role of immature granulocytes (Ig) as markers of inflammatory response in distinguishing between biliary colic and ABC.
Material and Methods: This retrospective study included 150 patients who presented with abdominal pain and were found to have or were diagnosed with gallstones. Patients were divided into biliary colic and ABC groups. Laboratory values of the patients, such as age, white blood cell count (WBC), hemoglobin, platelet, mean platelet volume, red cell distribution width, neutrophil (Neu), lymphocyte, Ig%, Ig number, and C-reactive protein (CRP) were recorded in the study form. Receiver operating characteristic and regression analysis were performed for the diagnosis of ABC.
Results: We found that the WBC, Neu, and Ig counts were statistically significantly higher in patients with ABC than in those with biliary colic. However, in the regression analysis, only the Murphy’s sign and CRP value were found to be significant in the diagnosis of ABC [p<0.001, odds ratio (OR): 0.119 [95% confidence interval (CI): 0.053-0.268], p=0.002, OR: 1.007 (95% CI: 1.002-1.011), respectively].
Conclusion: Although the Ig number was statistically significant in distinguishing between ABC and biliary colic, we believe that the CRP value and Murphy’s sign are superior parameters.

Keywords: Acute biliary cholecystitis, biliary colic, gallstones, immature granulocytes, abdominal pain