Diagnostic Utility of Prognostic Nutritional Index, Systemic Immune-Inflammation Index and Related Indices for Hinchey-Based Severity Stratification in Acute Diverticulitis: A Retrospective Cross-Sectional Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Acute diverticulitis is a common gastrointestinal emergency with a wide spectrum of clinical severity. The Hinchey classification, based on abdominal computed tomography (CT), remains the gold standard for staging, but timely imaging may not always be feasible in resource-limited or emergency settings. In this context, blood-derived indices may serve as useful adjuncts for early risk stratification. AIM: This study aimed to evaluate the diagnostic utility of inflammatory and nutritional indices-including the prognostic nutritional index (PNI), systemic immune-inflammation index (SII), inflammatory prognostic index (IPI), C-reactive protein-to-albumin ratio (CAR), and CRP-albumin-lymphocyte index (CALLY)-in predicting disease severity according to the Hinchey classification. METHODS: In this retrospective cross-sectional study, 64 patients diagnosed with acute diverticulitis between 2014 and 2024 were included. All patients underwent CT-based staging and laboratory testing on admission. Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic performance of each index across Hinchey stages 1a to 4. RESULTS: PNI showed the highest accuracy in predicting Hinchey 1a [area under the curve (AUC) = 0.778, sensitivity = 80 %, specificity = 66 %]. SII demonstrated excellent performance in identifying stage 4 (AUC = 0.935), while IPI was most effective in stage 3 (AUC = 0.945). CAR and CALLY showed moderate diagnostic value in later stages. CONCLUSION: PNI and SII may serve as practical and cost-effective tools for staging acute diverticulitis when imaging is delayed. These indices may assist in early clinical decision-making, especially in emergency and low-resource settings.
Institution: Bolu Abant İzzet Baysal University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7117495402