Effectiveness of Systemic Inflammation Response Index (SIRI) Neutrophil–Lymphocyte Ratio (NLR), Derived Neutrophil–Lymphocyte Ratio (dNLR), and Systemic Immune Inflammation Index (SII) for predicting prognosis of acute diverticulitis - Report - MDSpire
Advertisement
Effectiveness of Systemic Inflammation Response Index (SIRI) Neutrophil–Lymphocyte Ratio (NLR), Derived Neutrophil–Lymphocyte Ratio (dNLR), and Systemic Immune Inflammation Index (SII) for predicting prognosis of acute diverticulitis
Prognostic Value of SIRI, NLR, dNLR, and SII in Acute Diverticulitis Outcomes
Overview
This study evaluated the prognostic utility of systemic inflammation markers including SIRI, NLR, dNLR, and SII in patients with acute diverticulitis. Findings demonstrated that these markers, along with CRP and WBC, were significantly elevated in complicated acute diverticulitis and correlated strongly with Hinchey classification severity.
Background
Diverticulosis involves mucosal protrusions due to bowel wall deformities, potentially leading to complications such as acute diverticulitis. Differentiating between uncomplicated and complicated diverticulitis is critical for management but challenging based on clinical signs alone. Biomarkers like CRP, NLR, PLR, SII, and SIRI have emerged as noninvasive tools to assess inflammation and may aid in prognostication. The Hinchey classification, especially with CT imaging, remains a standard for categorizing diverticulitis severity.
Data Highlights
Parameter
Noncomplicated (SAD)
Complicated (CAD)
p-value
Number of patients
56
26
Mean Age (years)
60.5
60.5
NS
Hospital Stay (days)
Shorter
Longer
<0.001
Surgical/Interventional Rate
Lower
Higher
0.040
WBC
Lower
Higher
Significant
CRP
Lower
Higher
Significant
NLR
Lower
Higher
Significant
dNLR
Lower
Higher
Significant
SII
Lower
Higher
Significant
SIRI
Lower
Higher
Significant
PLR
Higher
Higher
NS
MLR
Higher
Higher
NS
Key Findings
Patients with complicated acute diverticulitis (CAD) had significantly higher WBC, CRP, NLR, dNLR, SII, and SIRI values compared to those with simple acute diverticulitis (SAD).
PLR and MLR were elevated in CAD but did not reach statistical significance.
There was a strong positive correlation between Hinchey classification severity and inflammatory markers including WBC, CRP, NLR, dNLR, SII, and SIRI.
Duration of hospital stay and rates of surgical or percutaneous interventions were significantly greater in CAD patients.
The study is unique in evaluating SIRI and dNLR as prognostic markers in acute diverticulitis, expanding on prior research focused mainly on NLR and PLR.
Clinical Implications
Systemic inflammatory markers such as SIRI, NLR, dNLR, and SII can serve as valuable, noninvasive adjuncts to imaging and clinical assessment in stratifying acute diverticulitis severity. Elevated levels of these markers may identify patients at higher risk for complicated disease who require closer monitoring and potentially more aggressive intervention. Incorporating these biomarkers could optimize patient management and reduce unnecessary imaging.
Conclusion
SIRI, NLR, dNLR, and SII are effective prognostic biomarkers correlating with the severity of acute diverticulitis as classified by Hinchey stages. Their use may enhance clinical decision-making in differentiating complicated from uncomplicated cases.
References
Hinchey et al. 1978 -- Classification of acute diverticulitis
Wasvary et al. 1999 -- Modified Hinchey classification including CT findings
Kaiser et al. 2005 -- CT-based Hinchey classification
Zahorec 2001 -- NLR as marker of inflammation
Recent study 2023 -- Use of SIRI and dNLR in acute diverticulitis prognosis
