Akut divertikülitte enflamatuvar parametrelerin tanýsal ve prognostik önemi: Geriye dönük kohort çalýþmasý

AMAÇ: Akut divertikülit tanýsý ve þiddetinin belirlenmesinde optimum biyokimyasal veya hematolojik belirteç henüz belirlenememiþtir. Bu çalýþmada, akut divertikülit tanýsýnda ve hastalýðýn þiddetinde nötrofil-lenfosit oraný gibi hematolojik parametrelerin etkinliðinin karþýlaþtýrýlmasýný amaçladýk.
GEREÇ VE YÖNTEM: Divertiküler hastalýk tanýsý alan 69 hasta (akut divertikülit ve divertiküloz alt gruplarý) ve kontrol grubunda 36 hasta çalýþmaya dahil edildi. Taný anýnda yapýlan biyokimyasal analizler arasýnda beyaz küre sayýsý, ortalama trombosit hacmi, nötrofil sayýsý, trombosit sayýsý ve C-reaktif protein deðerleri çalýþmaya alýndý. Nötrofil-lenfosit oraný ve trombosit-lenfosit oraný hesaplandý. Akut divertikülit grubunda abdominal tomografi bulgularýna dayalý Hinchey sýnýflamasýna göre dört gruba ayrýldý.
BULGULAR: Akut divertikülit ve divertikülozis gruplarýndaki ortalama trombosit-lenfosit oraný, kontrol grubuna göre anlamlý olarak daha düþüktü (p<0.05). Akut divertikülit ve divertikülozis ayrýmýnda en iyi duyarlýlýk ve özgüllük deðerleri nötrofil-lenfosit oraný 2.78 ve üzeri için kestirim (cut-off) deðerinde %63.64 ve %72.22 ve trombosit-lenfosit oraný 87.46 ve üzeri için kestirim deðerinde %30.30 ve %86.11 olarak bulundu. Akut divertikülit ve kontrol grubu ayrýmýnda en iyi duyarlýlýk ve özgüllük deðerleri, nötrofil-lenfosit oraný 11.55 ve üzeri kestirim deðerinde sýrasýyla %100 ve %0 iken trombosit-lenfosit oraný 12.28 ve üzeri kestirim deðerinde ise sýrasýyla %100 ve %100 olarak tespit edildi. Nötrofil-lenfosit oraný Hinchey evre 1’de evre 2 ve 3’e göre anlamlý derecede düþüktü (sýrasýyla, p=0.003, p=0.006).
TARTIÞMA: Nötrofil-lenfosit oraný ve trombosit-lenfosit oraný gibi hematolojik parametreler divertiküloz ve divertikülitin ayýrýcý tanýsý ve divertikülitte prognozu belirlemek için yararlý biyomarker olarak kullanýlabilir.

Diagnostic and prognostic significance of inflammatory parameters in acute diverticulitis: A retrospective cohort study

BACKGROUND: The optimum biochemical or hematological marker to determine diagnosis and severity of acute diverticulitis has not been established. We aimed to compare the utility of hematological parameters in the diagnosis and severity of acute diverticulitis.
METHODS: Sixty-nine patients in diverticular disease (acute diverticulitis and diverticulosis subgroups) and 36 patients in control group were included in the study. The biochemical analysis performed at the time of diagnosis included white blood cell, mean platelet volume, neutrophil count, platelet count (PLT), C-reactive protein, and calculation of neutrophil count/lymphocyte and PLT/lymphocyte ratios. Patients in the diverticulitis group were divided into four stages according to the Hinchey classification based on abdominal CT findings.
RESULTS: The mean platelet-lymphocyte ratio in the diverticulitis and diverticulosis groups was significantly lower than that in the control group (p<0.05). The best sensitivity and specificity values to distinguish acute diverticulitis and diverticulosis were 63.64% and 72.22% for the neutrophil-lymphocyte ratio (NLR) at a cutoff value of 2.78 and above and 30.30% and 86.11% for the platelet-lymphocyte ratio at a cutoff value of 87.46 and above. The diagnostic accuracy rates to distinguish between the diverticulitis and the control groups that the best sensitivity and specificity values were found to be NLR at a cutoff value of 11.55 and above and 100% and 100% for the platelet-lymphocyte ratio at a cutoff value of 12.28 and above. The NLR values were significantly lower in patients with Hinchey Stage 1 disease than those in patients with Stages 2 and 3 disease (respectively, p=0.003 and p=0.006).
CONCLUSION: NLR and platelet-lymphocyte ratio can serve as useful biomarkers for the differential diagnosis and severity in acute diverticulitis.