Purpose

The purpose of this study was to evaluate in-hospital mortality and morbidity associated with diverticulitis in immunosuppressed patients compared to non-immunosuppressed patients, and to identify risk factors for complicated disease.

Material and Methods

This retrospective study included 227 consecutive patients receiving inpatient treatment for colonic diverticulitis at our department between 04/2008 and 04/2014. The groups were divided in immunocompetent and immunosuppressed patients. Primary endpoints were mortality and morbidity during treatment. Secondary endpoint was the identification of risk factors for death in immunosuppressed patients.

Results

In a total of 227 treated patients, 15 (6.6%) were receiving immunosuppressive therapy due to transplantation (n=10; kidney 6x, lung 3x, liver 1x), autoimmune disease (n=4; vasculitis 2x, SLE 1x, myelitis 1x) or cerebral metastasis of NSCLC (n=1). Baseline characteristics like age (p=0.75), ratio of antibiotic treatment (p=0.92), maximum of CRP (p=0.10) and number of acute inflammatory episodes (p=0.12) showed no difference between the two groups. In contrast, immunosuppressed patients showed longer in-hospital stay (27.6 vs. 14.5 days; p=0.02) and longer stay at ICU (9.8 vs. 1.1 days; p<0.001). 13 of 15 immunosuppressed patients suffered of bowel perforation (Hansen/Stock 2b+2c) and showed therefore significant higher morbidity (p=0.04), higher rate of emergency operations (66% vs. 29.2%; p=0.02) and in-hospital mortality (20% vs. 4.7%; p=0.04). The analysis of potential predictors for death included level of immunosuppression at admission, age, maximum CRP, resistance in bacterial infection and smoking habits was not conclusive. Two of the three immunosuppressed patients who died in hospital had their first noticed diverticulitis episode.

Conclusion

Our study confirms that diverticulitis in immunosuppressed patients is associated with higher morbidity and mortality (20%) compared to immunocompetent patients. Due to the sample size (n=15) potential risk factors could not be identified.

Given the significance in in-hospital mortality, early diagnosis and treatment is crucial to prevent death in immunosuppressed patients. A suggested new approach could be a prophylactic sigma resection for patients with diverticulosis at the time of transplant listing, in particular because the first episode of diverticulitis can already be fatal.

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