Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T).

"Declarations Conflict of interestThe authors declare that they have no conflict of interest. Ethical approvalAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of the Area Vasta Nord Ovest (University of Pisa) (Wires-t n. 17575). Consent to participateInformed consent was obtained from all individual participants included in the study. Conflict of interest The authors declare that they have no conflict of interest."

"Funding Open access funding provided by Università di Pisa within the CRUI-CARE Agreement. No funding was received for conducting this study."

"We analyzed the data of patients with acute diverticulitis included in a multicenter international registry [Web-based International Registry of Emergency Surgery and Trauma (WIRES-T)] []. The project has been registered at ClinicalTrials.gov (NCT03643718) and includes data from patients worldwide. The study period was January 2018 to December 2021. The study was approved by the local ethics committee (Comitato Etico Area Vasta Nord Ovest Wires-t n. 17,575). Diagnosis of acute diverticulitis was carried out by clinical examination, laboratory tests, and computed tomography (CT) scan showing inflamed diverticula in the left colon and sigmoid with or without signs of complications. In some hospitals, according to the admission policy, patients with lower grades of acute diverticulitis may be treated in medical units. Two groups were identified: medical therapy (group A) and surgical therapy (group B). Each group was then divided into three subgroups based on the degree of immunocompromise: immunocompetent (grade 0), mildly to moderately immunocompromised (grade 1), and severely immunocompromised (grade 2) [, ]. A score of 1 was assigned to patients with one or more of the following conditions: aged > 70 years; active malignancy without chemotherapy; rheumatologic disorders (therapy without steroids but with other immunosuppressants); inflammatory bowel disease (therapy without steroids but with other immunosuppressants); diabetes; malnutrition (Nutrition Risk Screening > 3); chronic kidney disease with stages IIIb, IV, and V (according to the glomerular filtration rate); chronic hepatic disease (Child–Pugh class B–C); neurodegenerative disease. A score of 2 was assigned to patients presenting with one or more of the following conditions: leukemia or lymphoma, neutropenia (neutrophil count < 1000/mm3), ongoing chemotherapy, transplant (solid organ, bone marrow), high-dose steroids therapy (> 20 mg/day prednisone), or acquired immunodeficiency syndrome (AIDS) (with CD4 + count < 200/mm). All patients who did not have any of the above criteria were assigned a score of 0 (Table )."