Ocaña Juan, García-Pérez Juan Carlos, Fernández-Martínez Daniel, Aguirre Ignacio, Pascual Isabel, Lora Paola, Espin-Basany Eloy, Labalde-Martínez María, León Carmen, Pastor-Peinado Paula, López-Domínguez Carlota, Muñoz-Plaza Nerea, Valle Ainhoa, Dujovne Paula, Alías David, Pérez-Santiago Leticia, Correa Alba, Carmona María, Fernández-Cebrián José María, Die Javier
Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Division of Coloproctology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Colorectal Dis. 2024 Jan;26(1):120-129. doi: 10.1111/codi.16810. Epub 2023 Nov 27.
Management of diverticulitis with abscess formation in immunosuppressed patients (IMS) remains unclear. The main objective of the study was to assess short- and long-term outcomes between IMS and immunocompetent patients (IC). The secondary aim was to identify risk factors for emergency surgery.
A nationwide retrospective cohort study was performed at 29 Spanish referral centres between 2015-2019 including consecutive patients with first episode of diverticulitis classified as modified Hinchey Ib or II. IMS included immunosuppressive therapy, biologic therapy, malignant neoplasm with active chemotherapy and chronic steroid therapy. A multivariate analysis was performed to identify independent risk factors to emergency surgery in IMS.
A total of 1395 patients were included; 118 IMS and 1277 IC. There were no significant differences in emergency surgery between IMS and IC (19.5% and 13.5%, p = 0.075) but IMS was associated with higher mortality (15.1% vs. 0.6%, p < 0.001). Similar recurrent episodes were found between IMS and IC (28% vs. 28.2%, p = 0.963). Following multivariate analysis, immunosuppressive treatment, p = 0.002; OR: 3.35 (1.57-7.15), free gas bubbles, p < 0.001; OR: 2.91 (2.01-4.21), Hinchey II, p = 0.002; OR: 1.88 (1.26-2.83), use of morphine, p < 0.001; OR: 3.08 (1.98-4.80), abscess size ≥5 cm, p = 0.001; OR: 1.97 (1.33-2.93) and leucocytosis at third day, p < 0.001; OR: 1.001 (1.001-1.002) were independently associated with emergency surgery in IMS.
Nonoperative management in IMS has been shown to be safe with similar treatment failure than IC. IMS presented higher mortality in emergency surgery and similar rate of recurrent diverticulitis than IC. Identifying risk factors to emergency surgery may anticipate emergency surgery.
免疫抑制患者（IMS）合并脓肿形成的憩室炎的管理尚不清楚。本研究的主要目的是评估IMS患者与免疫功能正常患者（IC）的短期和长期结局。次要目的是确定急诊手术的危险因素。
2015年至2019年期间，在西班牙的29个转诊中心进行了一项全国性回顾性队列研究，纳入首次发作的憩室炎患者，根据改良Hinchey分级为Ib级或II级。IMS包括免疫抑制治疗、生物治疗、接受积极化疗的恶性肿瘤以及慢性类固醇治疗。进行多变量分析以确定IMS患者急诊手术的独立危险因素。
共纳入1395例患者；118例IMS患者和1277例IC患者。IMS患者和IC患者的急诊手术率无显著差异（分别为19.5%和13.5%，p = 0.075），但IMS患者的死亡率更高（15.1%对0.6%，p < 0.001）。IMS患者和IC患者的复发率相似（分别为28%和28.2%，p = 0.963）。多变量分析显示，免疫抑制治疗，p = 0.002；OR：3.35（1.57 - 7.15）、游离气泡，p < 0.001；OR：2.91（2.01 - 4.21）、Hinchey II级，p = 0.002；OR：1.88（1.26 - 2.83）、使用吗啡，p < 0.001；OR：3.08（1.98 - 4.80）、脓肿大小≥5 cm，p = 0.001；OR：1.97（1.33 - 2.93）以及第三天白细胞增多，p < 0.001；OR：1.001（1.001 - 1.002）与IMS患者的急诊手术独立相关。
已证明IMS患者的非手术治疗是安全的，治疗失败率与IC患者相似。IMS患者在急诊手术中的死亡率更高，憩室炎复发率与IC患者相似。识别急诊手术的危险因素可能有助于预测急诊手术。
