Jaung Rebekah, Kularatna Malsha, Robertson Jason P, Vather Ryash, Rowbotham David, MacCormick Andrew D, Bissett Ian P
Department of Surgery, University of Auckland, ACH Support Building, Park Road, Grafton, Auckland, New Zealand.
Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland, New Zealand.
World J Surg. 2017 Sep;41(9):2258-2265. doi: 10.1007/s00268-017-4012-9.
The management of uncomplicated (Modified Hinchey Classification Ia) acute diverticulitis (AD) has become increasingly conservative, with a focus on symptomatic relief and supportive management. Clear criteria for patient selection are required to implement this safely. This retrospective study aimed to identify risk factors for severe clinical course in patients with uncomplicated AD.
Patients admitted to General Surgery at two New Zealand tertiary centres over a period of 18 months were included. Univariate and multivariate analyses were carried out in order to identify factors associated with a more severe clinical course. This was defined by three endpoints: need for procedural intervention, admission >7 days and 30-day readmission; these were analysed separately and as a combined outcome.
Uncomplicated AD was identified in 319 patients. Fifteen patients (5%) required procedural intervention; this was associated with SIRS (OR 3.92). Twenty-two (6.9%) patients were admitted for >7 days; this was associated with patient-reported pain score >8/10 (OR 5.67). Thirty-one patients (9.8%) required readmission within 30 days; this was associated with pain score >8/10 (OR 6.08) and first episode of AD (OR 2.47). Overall, 49 patients had a severe clinical course, and associated factors were regular steroid/immunomodulator use (OR 4.34), pain score >8/10 (OR 5.9) and higher temperature (OR 1.51) and CRP ≥200 (OR 4.1).
SIRS, high pain score and CRP, first episode and regular steroid/immunomodulator use were identified as predictors of worse outcome in uncomplicated AD. These findings have the potential to inform prospective treatment decisions in this patient group.
单纯性（改良欣奇分类Ia级）急性憩室炎（AD）的管理已变得越来越保守，重点在于症状缓解和支持性治疗。需要明确的患者选择标准以安全地实施这一治疗。这项回顾性研究旨在确定单纯性AD患者临床病程严重的危险因素。
纳入在新西兰两个三级中心普通外科住院18个月期间的患者。进行单因素和多因素分析以确定与更严重临床病程相关的因素。这由三个终点定义：需要进行手术干预、住院时间>7天和30天内再次入院；这些终点分别进行分析并作为综合结果进行分析。
共识别出319例单纯性AD患者。15例（5%）患者需要进行手术干预；这与全身炎症反应综合征（SIRS）相关（比值比[OR]为3.92）。22例（6.9%）患者住院时间>7天；这与患者报告的疼痛评分>8/10相关（OR为5.67）。31例（9.8%）患者在30天内需要再次入院；这与疼痛评分>8/10（OR为6.08）和首次发作的AD（OR为2.47）相关。总体而言，49例患者临床病程严重，相关因素包括经常使用类固醇/免疫调节剂（OR为4.34）、疼痛评分>8/10（OR为5.9）、体温较高（OR为1.51）和C反应蛋白（CRP）≥200（OR为4.1）。
SIRS、高疼痛评分和CRP、首次发作以及经常使用类固醇/免疫调节剂被确定为单纯性AD预后较差的预测因素。这些发现有可能为该患者群体的前瞻性治疗决策提供参考。
