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Do Inflammatory Indices Play a Role in Distinguishing between Uncomplicated and Complicated Diverticulitis?
John Hogan1, Rishabh Sehgal, Dermot Murphy
1Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland.
Insights
Inflammatory indices like C-reactive protein and white cell lymphocyte ratio can help differentiate acute diverticulitis severity. These markers, when used with imaging, aid in diagnosing complicated diverticulitis.
Area of Science:
- Gastroenterology
- Medical Diagnostics
- Inflammatory Diseases
Background:
- The diagnostic utility of inflammatory markers for acute diverticulitis severity is not well-established.
- Differentiating uncomplicated from complicated diverticulitis is crucial for appropriate patient management.
Purpose of the Study:
- To evaluate the effectiveness of inflammatory indices and hematological ratios in distinguishing between uncomplicated and complicated acute diverticulitis.
- To identify specific cut-off points for these markers that correlate with disease severity.
Main Methods:
- A retrospective analysis of CT-confirmed acute diverticulitis cases (n=228) was performed.
- Classification and Regression Tree (CART) analysis identified optimal marker cut-offs in a training set.
- Predictive accuracy was assessed using logistic regression and ROC curves in a test set.
Main Results:
- C-reactive protein >109 mg/ml (AUC=0.64) and white cell lymphocyte ratio (WLR) >17.72 (AUC=0.64) were the most effective discriminators of complicated diverticulitis.
- White cell count (WCC) and lymphocyte count showed lower predictive accuracy.
Conclusions:
- Standard inflammatory indices are valuable in assessing the severity of acute diverticulitis.
- The identified marker cut-offs, alongside radiological findings, can aid in the diagnosis of complicated diverticulitis.
Background:
The usefulness of inflammatory indices in assessment of the severity of acute diverticulitis remains unestablished. The aim of this study was to determine whether inflammatory indices and hematological ratios could be utilised to differentiate between uncomplicated and complicated diverticulitis.
Methods:
Hematological and inflammatory indices were recorded for each admission with CT confirmed acute diverticulitis (101 complicated, 127 uncomplicated). Cases were divided into training (n = 57) and test sets (n = 171). A classification and regression tree (CART) analysis was employed in the training set to identify optimal inflammatory marker cut-off points associated with complicated diverticulitis. Samples (test set) were then categorized as (A) greater than and (B) less than CART identified cut-off points. The predictive properties of inflammatory marker cut-off points in distinguishing severity of diverticulitis were assessed using a univariate logistic regression analysis, summary receiver operating characteristic curves and confusion matrix generation.
Results:
C-reactive protein >109 mg/ml (OR 3.07, 95% CI 1.43-6.61, p = 0.004, area under the curve; AUC = 0.64) and white cell lymphocyte ratio (WLR) >17.72 (OR 4.23, 95% CI 1.95-9.17, p < 0.001, AUC = 0.64) were the most accurate parameters in distinguishing complicated and uncomplicated disease. WCC >21 × 109/l (p = 0.02, AUC = 0.60) and lymphocyte count >0.55 × 109/l (p = 0.009, AUC = 0.60) were less accurate.
Conclusion:
Widely used inflammatory indices are useful in the depiction of complicated diverticulitis. The indices cut-off points highlighted in this study should be considered at the time of diagnosis in combination with radiological features of complicated diverticulitis.
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