Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)
Authors: Tartaglia Dario , Cremonini Camilla , Annunziata Elena , Catena Fausto , Sartelli Massimo , Kirkpatrick Andrew W. , Musetti Serena , Strambi Silvia , Chiarugi Massimo , Coccolini Federico ,   the WIRES-T for Acute Diverticulitis Study Group, Salvetti Francesco , Fugazzola Paola , Ceresoli Marco , Benedetti Fabio , Elisa Nita Gabriela , Litvin Andrey , Lostoridis Eftychios , Ahmed Ali Yasen Yasen Mohamed , Manatakis Dimitrios , Negoi Ionut , Ioannidis Orestis , Uzunoglu Mustafa Yener , Tochie Joel Noutakdie , Cillara Nicola , Tomadze Gia , Bala Miklosh , Isik Arda , Fonseca Vinicius Cordeiro , Bellanova Giovanni , Ghannam Wagih , Yalkin Omer , Garcia Fernando Hernandez , Altintoprak Fatih , Hadzhiev Dimitar , Chirica Mircea , Zese Monica , Balalis Dimitros , Cui Yunfeng , Luppi Davide , Romeo Luigi , Muratore Andrea , Lunghi Elia Giuseppe , Yovtchev Yovtcho , Dimitrov Evgeni , Nikolopoulos Ioannis , Omerovic Maid , Zizzo Maurizio , Ugoletti Lara , Costa Gianluca , Scalzone Rocco , Perrone Stefano , Occhionorelli Savino , Nardi Matteo , Gubbiotti Francesca , Muhtaroglu Ali , Scaramuzzo Rosa , Corte Helene , Yanez Carlos , Zakaria Andee Dzulkarnaen , Seretis Charalampos , Gelmini Roberta , Pappalardo Vincenzo , Paratore Filippo , Sydorchuk Ruslan , Mulita Francesk , Kara Yasin , Toma Elena Adelina , Vailas Michail , Sotiropoulou Maria , Elbahnasawy Mahamad , Sibilla Maria Grazia , Martines Gennaro , Goksoy Beslen , Hadzhiev Dimitar , Parini Dario , Zaghi Claudia , Podda Mauro , Osipov Aleksey , Brisinda Giuseppe , Gambino Giovanni , Doklestic Lali Akhmeteli Krstina , Loncar Zlatibor , Micic Dusan , Lešević Ivana , D’Agostino Francesca , Garzali Ibrahim Umar , Caicedo Yaset , Marcela Lina , Marin Paola Andrea Gasca , Perivoliotis Konstantinos , Ntentas Ioannis , Kuptsov Arthur , Chowdhury Sharfuddin , Patel Tapan 
Published: February 2023

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.