A Retrospective Study on Use of Neutrophil-Lymphocyte Ratio as a Prognostic Measurement to Assess Acute Diverticulitis.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.