Comparative outcomes of acute colonic diverticulitis in immunocompromised versus immunocompetent patients: a systematic review and meta-analysis
Intest Res. 2023;21(4):481-492
Many clinicians have encountered cases of colonic diverticulitis in their clinical practice. Some of these cases are complicated by the presence of abscesses, peritonitis, strictures, fistulas or even sepsis. Immunocompromised patients are known to be at a higher risk of developing complicated forms of disease. However, the complete assessment of the clinical trajectories of diverticulitis in immunocompromised patients, including parameters such as mortality, surgical intervention, hospitalization, and occurrence of complications, has not been comprehensively explored to date.
This study endeavors to elucidate the clinical outcomes of diverticulitis in immunocompromised patients compared with immunocompetent individualsby means of a systemic review and meta-analysis encompassing data from 10 carefully selected studies. The assessed outcomes included the necessity for surgical intervention, the incidence of complications, mortality rates, the duration of hospitalization, recurrence rate, and the occurrence of major post-elective surgery morbidities.
- The overall risk of surgical intervention, whether elective or emergent, did not exhibit significant differences between immuocompromised and immunocompetent patients presenting with acute colonic diverticulitis. However, the risk of emergent surgery was notably higher in the immunocompromised patients.
- Complications associated with acute colonic diverticulitis did not significantly differ between immunocompromised and immunocomptent patients.
- Among immunocompromised patients, the overall mortality after acute colonic diverticulitis was significantly higher than that of their immunocompetent counterparts. This elevated risk of mortality was also observed following emergent surgery in immunmocompromised patients. Nonetheless, there was no statistically significant disparity in the risk of mortality after elective surgery between the two groups.
- Immunocompromised patients experienced significantly longer hospitalization period due to diverticulitis compared to immunocomptent subjects.
- During the follow-up period, there was no significant differences in recurrence rate between the two groups.
- In contrast to the trend observed in mortality rates after elective surgery, the incidence of post-electibve surgery morbidities was higher in immunocompromised patients compared to their immunocompetent counterparts. These morbidities encompassed surgical complications, abscesses, sepsis, ileus, cardiovascular issues, pulmonary complications, thromboembolic events, renal complications, and urinary tract problems.
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Read more about the intricate outcomes of diverticulitis in patients with immunocompromised status.
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