Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)

Abstract

Background Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis. Methods We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2). Results Data from 482 patients were analyzed—229 patients (47.5%) [M:F = 1:1; median age: 60 (24–95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26–94) years] in group B. There was a significant difference between the two groups in grade distribution: 69.9% versus 38.3% for grade 0, 26.6% versus 51% for grade 1, and 3.5% versus 10.7% for grade 2 (p < 0.00001). In group A, severe sepsis (p = 0.027) was more common in higher grades of immunodeficiency. Patients with grade 2 needed longer hospitalization (p = 0.005). In group B, a similar condition was found in terms of severe sepsis (p = 0.002), quick Sequential Organ Failure Assessment score > 2 (p = 0.0002), and Mannheim Peritonitis Index (p = 0.010). A Hartmann’s procedure is mainly performed in grades 1–2 (p < 0.0001). Major complications increased significantly after a Hartmann’s procedure (p = 0.047). Mortality was higher in the immunocompromised patients (p = 0.002). Conclusions Immunocompromised patients with acute diverticulitis present with a more severe clinical picture. When surgery is required, immunocompromised patients mainly undergo a Hartmann’s procedure. Postoperative morbidity and mortality are, however, higher in immunocompromised patients, who also require a longer hospital stay.

Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group

“…Tartaglia et al. in a recent study reported higher complications (70%) in IMS than IC (22%) [36]. Likewise, Al‐Khami et al.…”

Intra-abdominal infections survival guide: a position statement by the Global Alliance For Infections In Surgery

“…Diagnosis and treatment in immunocompromised patients can be challenging. Immunocompromised patients with IAIs are at increased risk of morbidity and mortality [145][146][147], and may fail standard NOM when otherwise indicated. As such, most patients require surgical intervention.…”

The Sіgnіfіcance of Changes Іn Prіmary Hemostasіs Durіng Abdomіnal Sepsіs as a Possіble Mechanіsm of Spіke Formatіon

“…На рівні мікроциркуляторного русла, при гострому запаленні, встановлена роль тромбоцитів в порушенні реологічних властивостей крові [1,2]. Тромбоцити є активним компонентом гострої запальної реакції: Після пошкодження ендотелію активовані тромбоцити адгезуються до субендотеліально розташованих колагенових волокон, виділяючи адгезивні білки та фактори (реакція вивільнення), що підвищують гемокоагуляцію, збільшують судинну проникливість та викликають хемотаксис поліморфноядерних лейкоцитів та інших проінфламматорних клітин (пряма дія катіонного протеїну тромбоцитів), а також синтезують тромбоксан А 2 -потужний агент вазоконстрикції та адгезії тромбоцитів [3][4][5]. Таким чином, початок запалення на рівні мікроциркуляторного русла взаємопов'язаний з початком гемокоагуляції [6].…”