Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)
Dario Tartaglia, Camilla Cremonini, Elena Annunziata, Fausto Catena, Massimo Sartelli, Andrew W. Kirkpatrick, Serena Musetti, Silvia Strambi, Massimo Chiarugi, Federico Coccolini, the WIRES-T for Acute Diverticulitis Study Group, Francesco Salvetti, Paola Fugazzola, Marco Ceresoli, Fabio Benedetti, Nita Gabriela Elisa, Andrey Litvin, Eftychios Lostoridis, Ali Yasen Yasen Mohamed Ahmed, Dimitrios K. Manatakis, Ionuţ Negoi, Orestis Ioannidis, Mustafa Yener Uzunoğlu, Joël Noutakdie Tochie, Nicola Cillara, Gia Tomadze, Miklosh Bala, Arda Işık, Vinicius Cordeiro Fonseca, Giovanni Bellanova, Wagih Ghannam, Ömer Yalkın, Fernando Hernandez Garcia, Fatih Altıntoprak, Dimitar Hadzhiev, Mircea Chirica, Monica Zese, Dimitros Balalis, Yunfeng Cui, Davide Luppi, Luigi Romeo, Andrea Muratore, Elia Giuseppe Lunghi, Yovtcho Yovtchev, Evgeni Dimitrov, Ioannis Nikolopoulos, Maid Omerović, Maurizio Zizzo, Lara Ugoletti, Gianluca Costa, Rocco Scalzone, Stefano Perrone, Savino Occhionorelli, M Nardi, Francesca Gubbiotti, Ali Muhtaroğlu, Rosa Scaramuzzo, Hélène Corté, Carlos Yáñez, Andee Dzulkarnaen Zakaria, Charalampos Seretis, Roberta Gelmini, Vincenzo Pappalardo, Filippo Paratore, Ruslan Sydorchuk, Francesk Mulita, Yasi̇n Kara, Elena Toma, Michail Vailas, Maria Sotiropoulou, Mahamad Elbahnasawy, Maria Grazia Sibilla, Gennaro Martines, Beslen Göksoy, Dimitar Hadzhiev, Dario Parini, Claudia Zaghi, Mauro Podda, Aleksey Osipov, Giuseppe Brisinda, Giovanni Gambino, Lali Akhmeteli Krstina Doklestic, Zlatibor Lončar, Dušan Micić, Ivana Lešević, Francesca D’Agostino, Ibrahım Umar Garzali, Yaset Caicedo, Lina Marcela, Paola Andrea Gasca Marin, Konstantinos Perivoliotis, Ioannis Ntentas, Arthur Kuptsov, Sharfuddin Chowdhury, Tapan Patel
Abstract
BACKGROUND: Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis. METHODS: We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2). RESULTS: Data from 482 patients were analyzed-229 patients (47.5%) [M:F = 1:1; median age: 60 (24-95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26-94) years] in group B. There was a significant difference between the two groups in grade distribution: 69.9% versus 38.3% for grade 0, 26.6% versus 51% for grade 1, and 3.5% versus 10.7% for grade 2 (p < 0.00001). In group A, severe sepsis (p = 0.027) was more common in higher grades of immunodeficiency. Patients with grade 2 needed longer hospitalization (p = 0.005). In group B, a similar condition was found in terms of severe sepsis (p = 0.002), quick Sequential Organ Failure Assessment score > 2 (p = 0.0002), and Mannheim Peritonitis Index (p = 0.010). A Hartmann's procedure is mainly performed in grades 1-2 (p < 0.0001). Major complications increased significantly after a Hartmann's procedure (p = 0.047). Mortality was higher in the immunocompromised patients (p = 0.002). CONCLUSIONS: Immunocompromised patients with acute diverticulitis present with a more severe clinical picture. When surgery is required, immunocompromised patients mainly undergo a Hartmann's procedure. Postoperative morbidity and mortality are, however, higher in immunocompromised patients, who also require a longer hospital stay.