Prognostic Value of Large Unstained Cells (LUC) in Assessing the Severity of Acute Cholecystitis

Objective:The Tokyo Guidelines 2018 (TG18) are widely used to evaluate the severity of acute cholecystitis.However, there remains a need for simpler and faster laboratory markers.This study aimed to assess whether the large unstained cell (LUC) percentage could serve as a useful biomarker for determining disease severity. Materials and Methods:This retrospective study included 300 patients diagnosed with acute cholecystitis between January 2019 and December 2023.Demographic characteristics, laboratory parameters, and radiological findings were reviewed.Based on TG18 criteria, patients were categorized into mild (Group 1), moderate (Group 2), and severe (Group 3) groups.The relationship between LUC% and disease severity was analyzed.Results: According to TG18 classification, 50.3% of patients (n=151) had mild, 32.3% (n=97) moderate, and 17.3% (n=52) severe acute cholecystitis.The median LUC% was 1.4% (range: 0.02-4.0).LUC values significantly differed across groups (p=0.006),being lower in Groups 2 and 3 compared to Group 1 (p=0.049and p=0.017, respectively).A weak but significant negative correlation was found between LUC% and TG18-defined disease severity (r=-0.184,p<0.001).A cut-off value of 0.75% for LUC% identified mild cases with 28.85% sensitivity and 88.07%specificity (AUC: 0.604, 95% CI: 0.540-0.667,p=0.002). Conclusion:LUC% is negatively associated with the severity of acute cholecystitis and may serve as a rapid, cost-effective, and accessible marker to support early clinical assessment.