Neutrophil-to-lymphocyte ratio: is it more valuable than CRP in assessing severity of acute diverticulitis at initial presentation? A single-center retrospective cohort study.

Abstract

Aim: We aim to evaluate the effectiveness of cheap, easily accessible, and simple biomarkers in determining the severity of diverticulitis according to the modified Hinchey classification.

Method: Patients were divided into two groups: complicated and uncomplicated diverticulitis. Laboratory test results of the two groups were compared. The same patients were divided into two groups: operated and non-operated patients. Laboratory test results of these two groups were compared.

Results: The study included 335 patients. Two hundred twenty patients (65.7%) were classified as having uncomplicated diverticulitis, and 115 patients (34.3%) were classified as having complicated diverticulitis. For CRP, the sensitivity was 53.9%, and the specificity was 69.1% in distinguishing between complicated and uncomplicated diverticulitis patients [AUC 0.648 (0.587-0.709)]. For NLR, the sensitivity was 80.9%, and the specificity was 58.6% [AUC 0.734 (0.678-0.791)]. Forty-nine patients (14.6%) were classified as having operated diverticulitis, and 286 patients (85.4%) were classified as having non-operated diverticulitis. For NLR, the sensitivity was 84.5%, and the specificity was 65.0% in distinguishing between operated and non-operated diverticulitis patients [AUC 0.789 (0.728-0.850)]. For CLR, the sensitivity was 85.7% and the specificity was 53.5% [AUC 0.735(0.664-0.805)].

Conclusion: In patients with acute diverticulitis, the NLR value is more successful than the CRP value in distinguishing between complicated and uncomplicated diverticulitis. Similarly, it can effectively predict whether patients with acute diverticulitis will require surgery. In addition, the CLR value predicts the need for surgery in patients with acute diverticulitis with high sensitivity.