General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy.
Department of Surgery, Bufalini" Hospital, Cesena, Italy.
Tech Coloproctol. 2023 Sep;27(9):747-757. doi: 10.1007/s10151-023-02758-6. Epub 2023 Feb 7.
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.
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).
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).
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.
患有急性憩室炎的免疫功能低下患者的发病率和死亡率较高。本研究旨在比较免疫功能低下和免疫功能正常的急性憩室炎患者的临床表现、治疗类型和结局。
我们比较了 2018 年 1 月至 2021 年 12 月期间从基于网络的国际急诊外科学和创伤登记处（WIRES-T）提取的急性憩室炎患者的数据。首先，将两组患者进行了识别：药物治疗（A 组）和手术治疗（B 组）。每组又分为三个亚组：非免疫低下（0 级）、轻度至中度免疫低下（1 级）和重度免疫低下（2 级）。
共分析了 482 例患者的数据，其中 229 例（47.5%）[M：F=1：1；中位年龄：60（24-95）岁]在 A 组，253 例（52.5%）[M：F=1：1；中位年龄：71（26-94）岁]在 B 组。两组在分级分布上存在显著差异：0 级分别为 69.9%和 38.3%，1 级分别为 26.6%和 51%，2 级分别为 3.5%和 10.7%（p<0.00001）。在 A 组中，严重脓毒症（p=0.027）在免疫缺陷程度较高的患者中更为常见。2 级患者的住院时间更长（p=0.005）。在 B 组中，在严重脓毒症（p=0.002）、序贯器官衰竭评估评分>2（p=0.0002）和曼海姆腹膜炎指数（p=0.010）方面也发现了类似的情况。主要在 1-2 级行Hartmann 手术（p<0.0001）。Hartmann 手术后主要发生重大并发症（p=0.047）。免疫低下患者的死亡率较高（p=0.002）。
患有急性憩室炎的免疫功能低下患者表现出更严重的临床表现。当需要手术时，免疫低下患者主要行 Hartmann 手术。然而，免疫低下患者术后发病率和死亡率较高，住院时间也较长。
