Can initial inflammatory markers predict length of stay in uncomplicated diverticulitis?

Aim: To investigate the ability of White Cell Count (WCC), Neutrophil count & C-Reactive Protein (CRP) levels at admission to predict length of stay (LOS) in patients with uncomplicated diverticulitis.

Method: This study was performed as a retrospective review of all patients admitted with CT proven uncomplicated diverticulitis over a one-year period. WCC, Neutrophils and CRP levels where recorded at admission. Uniform discharge criteria where used and length of stay measured. A correlation analysis was performed between the inflammatory markers and LOS.

Results: A total of 84 admissions with uncomplicated diverticulitis was included in this study. Average LOS 3.06 (range 1-7 days). On Romaadmission average CRP was 55 (1-276), WCC 11.5 (4.5-35.6) and Neutrophils 8.37 (2.3-18.9). Peak inflammatory values were also measured with mean peak CRP 93.5 (3-325), WCC 11.6 (5.1-35.6) and neutrophils 8.47 (2.3-18.9). Inflammatory markers were correlated to LOS. Multivariate analysis and Fit Plots showed no correlation between any of the inflammatory markers and LOS. Using a modified Hinchey classification 8 patients were Hinchey 0, 60 Hinchey Ia and 16 Hinchey Ib. Hinchey classification was associated with longer LOS (Hinchey 0 mean LOS 2.63 days, Hinchey Ia 2.71 days, Hinchey Ib 4.4 days).

Conclusion: There was a high degree of variation in the inflammatory markers at admission, as well as the peak level of these inflammatory markers during the patients stay. The extent to which these markers were raised did not correlate with the patients' length of stay. As such, the use of inflammatory markers has limited prognostic value in patients with uncomplicated diverticulitis.