背景：结肠憩室炎是腹痛的主要原因。单核细胞分布宽度（MDW）是一种新型的炎症生物标志物，对冠状病毒疾病和胰腺炎具有预后意义；然而，尚无研究评估其与结肠憩室炎严重程度的相关性.
方法：这项单中心回顾性队列研究包括年龄在18岁以上的患者，他们在2020年11月1日至2021年5月31日期间到急诊科就诊，并在腹部计算机断层扫描后诊断为急性结肠憩室炎。比较了单纯性和复杂性憩室炎患者的特征和实验室指标。使用卡方或Fisher精确检验评估分类数据的显著性。Mann-WhitneyU检验用于连续变量。进行多因素回归分析以确定复杂性结肠憩室炎的预测因子。使用受试者操作特征（ROC）曲线来测试炎性生物标志物在区分简单病例和复杂病例中的功效。
结果：在入选的160名患者中，21例（13.125％）患有复杂性憩室炎。尽管右侧结肠憩室炎比左侧结肠憩室炎更普遍(70%对30%),复杂性憩室炎在左侧结肠憩室炎患者中更为常见（61.905％，p=0.001)。年龄,白细胞（WBC）计数，中性粒细胞计数,C反应蛋白(CRP)水平,中性粒细胞与淋巴细胞比率（NLR），血小板与淋巴细胞比率（PLR），复杂性憩室炎组MDW明显高于对照组(p<0.05)。Logistic回归分析显示，左侧位置和MDW是复杂憩室炎的独立预测因素。ROC曲线下面积(AUC)如下:MDW,0.870(95%置信区间[CI]，0.784-0.956）；CRP，0.800（95%CI，0.707-0.892）；NLR，0.724（95%CI，0.616-0.832）；PLR，0.662（95%CI，0.525-0.798）；和白细胞，0.679（95%CI，0.563-0.795）。当MDW临界值为20.38时，灵敏度和特异性分别达到90.5%和80.6%，分别。
结论：大的MDW是复杂憩室炎的一个重要且独立的预测因子。MDW的最佳临界值为20.38，因为它具有区分简单和复杂憩室炎的最大敏感性和特异性。MDW可能有助于为急诊科结肠憩室炎患者计划抗生素治疗。
BACKGROUND: Colonic diverticulitis is a leading cause of abdominal pain. The monocyte distribution width (MDW) is a novel inflammatory biomarker with prognostic significance for coronavirus disease and pancreatitis; however, no study has assessed its correlation with the severity of colonic diverticulitis.
METHODS: This single-center retrospective cohort study included patients older than 18 years who presented to the emergency department between November 1, 2020, and May 31, 2021, and received a diagnosis of acute colonic diverticulitis after abdominal computed tomography. The characteristics and laboratory parameters of patients with simple versus complicated diverticulitis were compared. The significance of categorical data was assessed using the chi-square or Fisher\'s exact test. The Mann-Whitney U test was used for continuous variables. Multivariable regression analysis was performed to identify predictors of complicated colonic diverticulitis. Receiver operator characteristic (ROC) curves were used to test the efficacy of inflammatory biomarkers in distinguishing simple from complicated cases.
RESULTS: Of the 160 patients enrolled, 21 (13.125%) had complicated diverticulitis. Although right-sided was more prevalent than left-sided colonic diverticulitis (70% versus 30%), complicated diverticulitis was more common in those with left-sided colonic diverticulitis (61.905%, p = 0.001). Age, white blood cell (WBC) count, neutrophil count, C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and MDW were significantly higher in the complicated diverticulitis group (p < 0.05). Logistic regression analysis indicated that the left-sided location and the MDW were significant and independent predictors of complicated diverticulitis. The area under the ROC curve (AUC) was as follows: MDW, 0.870 (95% confidence interval [CI], 0.784-0.956); CRP, 0.800 (95% CI, 0.707-0.892); NLR, 0.724 (95% CI, 0.616-0.832); PLR, 0.662 (95% CI, 0.525-0.798); and WBC, 0.679 (95% CI, 0.563-0.795). When the MDW cutoff was 20.38, the sensitivity and specificity were maximized to 90.5% and 80.6%, respectively.
CONCLUSIONS: A large MDW was a significant and independent predictor of complicated diverticulitis. The optimal cutoff value for MDW is 20.38 as it exhibits maximum sensitivity and specificity for distinguishing between simple and complicated diverticulitis The MDW may aid in planning antibiotic therapy for patients with colonic diverticulitis in the emergency department.
