title: Do Inflammatory Indices Play a Role in Distinguishing between Uncomplicated and Complicated Diverticulitis?
abstract: BACKGROUND
  The usefulness of inflammatory indices in assessment of the severity of acute diverticulitis remains unestablished. The aim of this study was to determine whether inflammatory indices and hematological ratios could be utilised to differentiate between uncomplicated and complicated diverticulitis.
  
  
  METHODS
  Hematological and inflammatory indices were recorded for each admission with CT confirmed acute diverticulitis (101 complicated, 127 uncomplicated). Cases were divided into training (n = 57) and test sets (n = 171). A classification and regression tree (CART) analysis was employed in the training set to identify optimal inflammatory marker cut-off points associated with complicated diverticulitis. Samples (test set) were then categorized as (A) greater than and (B) less than CART identified cut-off points. The predictive properties of inflammatory marker cut-off points in distinguishing severity of diverticulitis were assessed using a univariate logistic regression analysis, summary receiver operating characteristic curves and confusion matrix generation.
  
  
  RESULTS
  C-reactive protein >109 mg/ml (OR 3.07, 95% CI 1.43-6.61, p = 0.004, area under the curve; AUC = 0.64) and white cell lymphocyte ratio (WLR) >17.72 (OR 4.23, 95% CI 1.95-9.17, p < 0.001, AUC = 0.64) were the most accurate parameters in distinguishing complicated and uncomplicated disease. WCC >21 × 109/l (p = 0.02, AUC = 0.60) and lymphocyte count >0.55 × 109/l (p = 0.009, AUC = 0.60) were less accurate.
  
  
  CONCLUSIONS
  Widely used inflammatory indices are useful in the depiction of complicated diverticulitis. The indices cut-off points highlighted in this study should be considered at the time of diagnosis in combination with radiological features of complicated diverticulitis.
authors.affiliation: Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Hogan
authors.forename: Rishabh
authors.initials: R
authors.lastname: Sehgal
authors.forename: Dermot
authors.initials: D
authors.lastname: Murphy
authors.forename: Peter
authors.initials: P
authors.lastname: O'Leary
authors.forename: J Calvin
authors.initials: JC
authors.lastname: Coffey
mesh_terms: D019540:Area Under Curve; D002097:C-Reactive Protein / Q000378:metabolism*; D004238:Diverticulitis / Q000097:blood* / Q000145:classification* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007962:Leukocytes; D018655:Lymphocyte Count; D008297:Male; D009504:Neutrophils; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D002097:C-Reactive Protein