Neutrophil-to-eosinophil ratio and c-reactive protein are predictors of surgery in acute diverticulitis
Abstract
Background: Patients with acute diverticulitis (AD) and Hinchey<III may also need surgery. Therefore, as other markers are needed to help deciding which patients should be operated on, we tried to test the value of the C-reactive protein (CRP) and of blood cell count (and their ratios).
Methods: Retrospective chart review of patients admitted to our surgical department between 2009 and 2011 with the diagnosis of AD. Only cases with a computed tomography confirmation were included in the study.
Results: 174 patients (147 men, 27 women, age range 24-93 years) presented with AD. 161 patients had a modified Hinchey classification <III and 17 patients were submitted to surgery (7 had Hinchey III or IV and 10 had Hinchey<III). The neutrophil-to-eosinophil ratio (NER) had the best discriminant value in deciding for a surgical procedure in the ROC (receiver operating characteristics) curve. NER discriminated non-surgical and surgical treatment with an area under the ROC curve of 0.86 (95% confidence interval (CI), 0.79-0.92). The cut-off>244.25 yielded a sensitivity of 80% (95% CI, 44-98%), a specificity of 86% (95% CI, 79-92%), a positive likelihood ratio of 5.85 (95% CI, 3.40-10.10) and a negative likelihood ratio of 0.23 (95% CI, 0.07-0.80). In fact, NER>244.25 successfully predicted 15 out of 17 cases that were operated on in our sample.
Conclusions: NER is a good marker in discriminating those that should be operated on regardless of the Hinchey category. However, more studies are needed to confirm these data.
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References
Soumian S, Thomas S, Mohan PP, Khan N, Khan Z, Raju T: Management of Hinchey Π diverticulitis. World J Gastroenterol 2008, 14:7163-7169.
Evans J: Does a 48-Hour Rule Predict Outcomes in Patients with Acute Sigmoid Diverticulitis? J Gastrointest Surg 2008, 12:577–582.
Ritz JP, Lehmann KS, Loddenkemper C, Frericks B, Buhr HJ, Holmer C: Preoperative CT staging in sigmoid diverticulitis – does it correlate with intraoperative and histological findings? Langenbecks Arch Surg 2010, 395:1009–1015.
Boostrom SY, Wolff BG, Cima RR, Merchea A, Dozois EJ, Larson DW: Uncomplicated Diverticulitis, More Complicated than We Thought. J Gastrointest Surg 2012, 16:1744–1749.
Moya P, Arroyo A, Pérez-Legaz J, Serrano P, Candela F, Soriano-Irigaray L et al: Applicability, safety and efficiency of outpatient treatment in uncomplicated diverticulitis. Tech Coloproctol 2012, 16:301–307.
Tursi A: Diverticular disease: a therapeutic overview. World J Gastrointest Pharmacol Ther 2010, 1:27-35.
Holland M, Alkhalil M, Chandromouli S: Eosinopenia as a marker of mortality and length of stay in patients admitted with exacerbations of chronic obstructive pulmonary disease. Respirology 2010, 15:165–167.
Abidi K, Khoudri I, Belayachi J, Madani N, Zekraoui A, Zeggwagh AA et al: Research Eosinopenia is a reliable marker of sepsis on admission to medical intensive care units. Critical Care 2008, 12:R59.
Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ: Neutrophil lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005, 91:181-4.
Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN: Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol 2009, 16:614-22.
Tursi A: Biomarkers in diverticular diseases of the colon. Dig Dis 2012, 30:12-8
World Health Organisation: The International Classification of Diseases, 9th Revision [http://icd9cm.chrisendres.com/index.php]
McNicol A, Israels SJ: Beyond Hemostasis: The Role of Platelets in Inflammation, Malignancy and Infection. Cardiovasc & Haematol Disord Drug Targets 2008, 8:99-117.
Luan YY, Dong N, Xie M, Xiao XZ, Yao YM: The significance and regulatory mechanisms of innate immune cells in the development of sepsis. J Interferon Cytokine Res 2014, 34:2-15.
*O’Mahony JB, Palder SB, Wood JJ, McIrvine A, Rodrick ML et al: Depression of cellular immunity after multiple trauma in the absence of sepsis. J Trauma. 1984, 24:869-75.
Lim SY, Jeon EJ, Kim HJ, Jeon K, Um SW, Koh WJ et al: The incidence, causes, and prognostic significance of new-onset thrombocytopenia in intensive care units: a prospective cohort study in a Korean hospital. J Korean Med Sci 2012, 27:1418-23.
Kim SY, Oh TH, Seo JY, Jeon TJ, Seo DD, Shin WC et al: The clinical factors for predicting severe diverticulitis in Korea: a comparison with Western countries. Gut Liver 2012, 6:78-85.
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