Ho Yam Ting, Perera Omattage M, Ayeni Femi E, Gregory Harrison, McMahon Hugh, Amarasekera Punkaja M S, Chan Yi-Che, Chang Jia Han, Chuang Tzu Yi, Coverdale Peter J
Department of Surgery, Ipswich Hospital, Ipswich, Australia.
Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, Kingswood, Australia.
ANZ J Surg. 2025 Jul-Aug;95(7-8):1532-1539. doi: 10.1111/ans.70220. Epub 2025 Jun 13.
Acute diverticulitis (AD) is a common surgical condition and the Neutrophil-lymphocyte ratio (NLR) is an emerging biomarker ratio used to guide its management. The aim of this study is to validate and assess the utility of the NLR in AD in the Australian population.
This is a single centre retrospective observational study of patients who presented to the emergency department with the diagnosis of AD between September 2018 and September 2023, in Ipswich, Queensland. One thousand five hundred and forty patients were screened against exclusion/inclusion criteria and 634 patients were available for analysis.
The study identified NLR, CRP (C-reactive protein) and age to be significant coefficients in predicting length of stay (LOS) in regression analysis. NLR (OR1.06, p < 0.001) and CRP (OR1.01, p < 0.001) were significant predictors for surgical management of diverticulitis. NLR was found to be superior predictor of surgical management in ROC analysis (AUC 0.75, sensitivity 65%, specificity 75%, p < 0.001) compared to CRP, but both were equivalent in predicting for diverticulitis severity and percutaneous drainage. Further analysis revealed NLR between those receiving surgery, percutaneous drainage and readmission (One-way ANOVA) and NLR between modified Hinchey classifications were also significantly different (Mann-Whitney U).
In this study, we have further validated the effectiveness of NLR as a diagnostic marker. In particular, NLR is superior to CRP in predicting surgical management. It has also proven useful to predict for LOS, disease severity and percutaneous drainage. NLR usage should be encouraged in the clinical setting as it is simple and effective.
急性憩室炎（AD）是一种常见的外科疾病，中性粒细胞与淋巴细胞比值（NLR）是一种新兴的生物标志物比值，用于指导其治疗。本研究的目的是验证并评估NLR在澳大利亚人群AD中的效用。
这是一项单中心回顾性观察研究，研究对象为2018年9月至2023年9月期间在昆士兰州伊普斯威奇市急诊科就诊并被诊断为AD的患者。根据排除/纳入标准对1540名患者进行筛选，634名患者可供分析。
回归分析显示，该研究确定NLR、C反应蛋白（CRP）和年龄是预测住院时间（LOS）的显著系数。NLR（OR 1.06，p < 0.001）和CRP（OR 1.01，p < 0.001）是憩室炎手术治疗的显著预测指标。在ROC分析中，与CRP相比，NLR是手术治疗的更好预测指标（AUC 0.75，敏感性65%，特异性75%，p < 0.001），但二者在预测憩室炎严重程度和经皮引流方面相当。进一步分析显示，接受手术、经皮引流和再次入院患者之间的NLR（单因素方差分析）以及改良欣奇分类之间的NLR也存在显著差异（曼-惠特尼U检验）。
在本研究中，我们进一步验证了NLR作为诊断标志物的有效性。特别是，NLR在预测手术治疗方面优于CRP。它在预测住院时间、疾病严重程度和经皮引流方面也被证明是有用的。由于NLR简单有效，应鼓励在临床环境中使用。
