Neutrophil-to-lymphocyte ratio as a predictor of complicated acute diverticulitis: A retrospective cohort study

Abstract

Introduction Currently, the debate on the usefulness of Neutrophil to Lymphocyte Ratio (NLR) as a predictor of complications in acute diverticulitis (AD) remains open, especially, the relation to the severity of the disease, the clinical impact, and the necessity of minimally invasive or emergency surgical procedures. On the other hand, its diagnostic efficacy has not been studied even in our field. The objective of the present study was to determine the utility and diagnostic precision of NLR in complicated acute diverticulitis (cAD). Methods Descriptive, retrospective cohort and analytical study. Patients older than 18 years with a diagnosis of AD were included, from 2013 to 2018. Demographic variables, days of hospitalization, leukocyte count, neutrophils, lymphocytes, ESR, CRP, and NLR were analyzed. The sensitivity and specificity for the diagnosis of cAD were determined using ROC curves. Results 325 patients were included. Of these 196 (60%) were men. The median age was 52 years. A total of 30 (9%) were categorized as cAD. The patients with cAD presented mean values in the leukocyte count (14.02 ± 4.49 × 10 9 /l; p < 0.01), CRP (119.60 ± 87.67; p < 0.01) and NLR (7.61 ± 4.03; p < 0.01). An NLR cutoff value ≥ 4.2 was identified as the most appropriate to distinguish cAD, with a sensitivity of 80%, a specificity of 64%, NPV of 96%, and PPV of 18%. Conclusion NLR is a predictive marker of cAD, with a cut-off point of 4.2 being the best diagnostic approach.

Hemogram-Derived Ratios in the Prognosis of Acute Diverticulitis

“…The prevalence of complicated AD in our study was similar to that reported by Zager et al [ 11 ] (44.2% ( n = 65) vs. 32.7% ( n = 149]), but was different from that reported by Palacios Huatuco et al [ 17 ] and Bharucha et al [ 4 ] (44.2% ( n = 65) vs. 9 % ( n = 30) vs. (12% ( n = 386)). In the complicated diverticulitis group, 29.93% ( n = 44) of patients had CT findings compatible with a diagnosis of Hinchey stage III.…”

“…We also found that patients with complicated AD were of a similar age to those with uncomplicated AD (median age, 59.22 vs. 62.05 years, p = 0.226). These findings are similar to those reported by Palacios Huatuco et al [ 17 ] and are different from those reported by Chang et al [ 18 ].…”

Utility of monocyte distribution width in the differential diagnosis between simple and complicated diverticulitis: a retrospective cohort study

“…One study reported that the NLR could predict the need for surgical intervention more accurately than the CRP level and WBC count [ 37 ]. Palacios Huatuco et al recently found the NLR cutoff of 4.2 to be the best diagnostic approach, with a sensitivity of 80% and specificity of 64%, for detecting complicated diverticulitis [ 38 ]. Mari et al found that the PLR had lower diagnostic accuracy than the NLR (AUC values, 0.67%, and 0.75%, respectively) [ 39 ].…”

Right-sided acute diverticulitis in the West: experience at a university hospital in Argentina

“…In a recent study, we demonstrated the utility of NLR to predict complicated LD, with a cutoff point of ≥ 4.2 as the best value of diagnostic approximation [ 23 ]. Similarly, in this cohort we found that NLR showed statistical significance in relation to the severity of Hinchey stage, validating its applicability as a reliable, noninvasive, and cost-effective marker in the early diagnosis of complicated DD.…”