PDF(Pubmed)
Abstract：
OBJECTIVE: Immunocompromised patients with acute colonic diverticulitis are at high risk for complications and failure of non-surgical treatment. However, evidence on the comparative outcomes of immunocompromised and immunocompetent patients with diverticulitis is lacking. This systematic review and meta-analysis investigated the outcomes of medical treatment in immunocompromised and immunocompetent patients with diverticulitis.
METHODS: A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library. Studies comparing the clinical outcomes of immunocompromised and immunocompetent patients with diverticulitis were included.
RESULTS: A total of 10 studies with 1,946,461 subjects were included in the quantitative synthesis. The risk of emergency surgery and postoperative mortality after emergency surgery was significantly higher in immunocompromised patients than in immunocompetent patients with diverticulitis (risk ratio [RR], 1.76; 95% confidence interval [CI], 1.31-2.38 and RR, 3.05; 95% CI, 1.70-5.45, respectively). Overall risk of complications associated with diverticulitis was non-significantly higher in immunocompromised than in immunocompetent patients (RR, 1.24; 95% CI, 0.95-1.63). Overall mortality irrespective of surgery was significantly higher in immunocompromised than in immunocompetent patients with diverticulitis (RR, 3.65; 95% CI, 1.73-7.69). By contrast, postoperative mortality after elective surgery was not significantly different between immunocompromised and immunocompetent patients with diverticulitis. In subgroup analysis, the risk of emergency surgery and recurrence was significantly higher in immunocompromised patients with complicated diverticulitis, whereas no significant difference was shown in mild disease.
CONCLUSIONS: Immunocompromised patients with diverticulitis should be given the best medical treatment with multidisciplinary approach because they had increased risks of surgery, postoperative morbidity, and mortality than immunocompetent patients.
METHODS: A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library. Studies comparing the clinical outcomes of immunocompromised and immunocompetent patients with diverticulitis were included.
RESULTS: A total of 10 studies with 1,946,461 subjects were included in the quantitative synthesis. The risk of emergency surgery and postoperative mortality after emergency surgery was significantly higher in immunocompromised patients than in immunocompetent patients with diverticulitis (risk ratio [RR], 1.76; 95% confidence interval [CI], 1.31-2.38 and RR, 3.05; 95% CI, 1.70-5.45, respectively). Overall risk of complications associated with diverticulitis was non-significantly higher in immunocompromised than in immunocompetent patients (RR, 1.24; 95% CI, 0.95-1.63). Overall mortality irrespective of surgery was significantly higher in immunocompromised than in immunocompetent patients with diverticulitis (RR, 3.65; 95% CI, 1.73-7.69). By contrast, postoperative mortality after elective surgery was not significantly different between immunocompromised and immunocompetent patients with diverticulitis. In subgroup analysis, the risk of emergency surgery and recurrence was significantly higher in immunocompromised patients with complicated diverticulitis, whereas no significant difference was shown in mild disease.
CONCLUSIONS: Immunocompromised patients with diverticulitis should be given the best medical treatment with multidisciplinary approach because they had increased risks of surgery, postoperative morbidity, and mortality than immunocompetent patients.
摘要：
■急性结肠憩室炎的免疫功能低下患者发生并发症和非手术治疗失败的风险很高。然而,缺乏关于免疫功能低下和免疫功能正常的憩室炎患者的比较结局的证据.这项系统评价和荟萃分析调查了免疫功能低下和免疫功能正常的憩室炎患者的药物治疗结果。
■在PubMed进行了全面的文献检索，Embase,还有Cochrane图书馆.包括比较免疫功能低下和免疫功能正常的憩室炎患者的临床结果的研究。
■在定量合成中包括总共10项研究，其中1,946,461名受试者。免疫功能低下患者的急诊手术风险和急诊手术后死亡率明显高于免疫功能正常的憩室炎患者（风险比[RR]，1.76；95%置信区间[CI]，1.31-2.38和RR，3.05；95%CI，分别为1.70-5.45）。在免疫功能低下的患者中，与憩室炎相关的并发症的总体风险没有显着升高（RR，1.24；95%CI，0.95-1.63）。免疫功能低下的患者与手术无关的总死亡率显着高于免疫功能正常的憩室炎患者（RR，3.65；95%CI，1.73-7.69）。相比之下,选择性手术后的死亡率在免疫功能低下和免疫功能正常的憩室炎患者之间没有显著差异.在亚组分析中，复杂憩室炎的免疫功能低下患者的急诊手术和复发风险明显更高，而轻度疾病没有显着差异。
患有憩室炎的免疫功能低下患者应通过多学科方法给予最佳药物治疗，因为他们的手术风险增加，术后发病率，和死亡率高于免疫功能正常的患者。
■在PubMed进行了全面的文献检索，Embase,还有Cochrane图书馆.包括比较免疫功能低下和免疫功能正常的憩室炎患者的临床结果的研究。
■在定量合成中包括总共10项研究，其中1,946,461名受试者。免疫功能低下患者的急诊手术风险和急诊手术后死亡率明显高于免疫功能正常的憩室炎患者（风险比[RR]，1.76；95%置信区间[CI]，1.31-2.38和RR，3.05；95%CI，分别为1.70-5.45）。在免疫功能低下的患者中，与憩室炎相关的并发症的总体风险没有显着升高（RR，1.24；95%CI，0.95-1.63）。免疫功能低下的患者与手术无关的总死亡率显着高于免疫功能正常的憩室炎患者（RR，3.65；95%CI，1.73-7.69）。相比之下,选择性手术后的死亡率在免疫功能低下和免疫功能正常的憩室炎患者之间没有显著差异.在亚组分析中，复杂憩室炎的免疫功能低下患者的急诊手术和复发风险明显更高，而轻度疾病没有显着差异。
患有憩室炎的免疫功能低下患者应通过多学科方法给予最佳药物治疗，因为他们的手术风险增加，术后发病率，和死亡率高于免疫功能正常的患者。
