Prognostic and severity value of the neutrophil-to-lymphocyte ratio in patients with acute diverticulitis: a systematic review with meta-analysis.

OBJECTIVE: This study evaluates the neutrophil-to-lymphocyte ratio (NLR) as a potential tool for assessing acute diverticulitis (AD) severity and prognosis. METHODS: A systematic search was conducted in PubMed, Embase, Scopus, Web of Science and Google Scholar. A meta-analysis compared mean NLR values between complicated and non-complicated AD patients and those who underwent surgery versus non-surgical management. RESULTS: Seventeen cohort studies were included. NLR >7.2 predicted mortality (sensitivity: 80%, specificity: 60%). The optimal NLR cutoff for predicting complicated AD was 4.862, with sensitivity of 74.17% (95% CI: 56.25%; 86.51%) and specificity of 68.41% (95% CI: 52.84%; 80.71%). The mean NLR was higher in the surgical group (MD: 2.85; 95% CI: -0.24; 5.95; I2: 86%). High NLR was associated with failure of non-surgical treatment (OR: 1.65; 95% CI: 0.47; 3.90). CONCLUSION: NLR may be a useful biomarker for AD severity and mortality risk. However, its relevance for predicting surgery need, treatment failure or recurrence is limited. Larger, prospective are needed to confirm its clinical utility.