Predictive factors for conservative treatment failure of right colonic diverticulitis

Abstract

Purpose Conservative treatment is the first-line therapy for acute colonic diverticulitis without severe complications, but treatment failure may increase hospitalization duration, medical costs, and morbidities. Usage of the modified Hinchey classification is insufficient to predict the outcome of conservative management. We aimed to investigate the clinical efficacy of the modified Hinchey classification and to evaluate predictive factors such as inflammatory markers for the failure of conservative management. Methods Patients diagnosed with right colonic diverticulitis undergoing conservative treatment at 3 hospitals between 2017 and 2019 were included. Patients were categorized into conservative treatment success (n = 494) or failure (n = 46) groups. Clinical characteristics and blood inflammatory markers were assessed. Results The conservative treatment failure group presented with more elderly patients (>50 years, P = 0.002), more recurrent episodes (P < 0.001), a higher lymphocyte count (P = 0.021), higher C-reactive protein (CRP) levels (P = 0.044), and higher modified Glasgow prognostic scores (P = 0.021). Multivariate analysis revealed that age of >50 years (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.27–5.08; P = 0.008), recurrent episodes (OR, 4.78; 95% CI, 2.38–9.61; P < 0.001), and higher CRP levels (OR, 1.08; 95% CI, 1.03–1.12; P = 0.001) were predictive factors for conservative treatment failure, but not the modified Hinchey grade (P = 0.159). Conclusion Age of >50 years, recurrent episodes, and CRP levels are potential predictors for conservative management failure of patients with right-sided colonic diverticulitis. Further studies are warranted to identify candidates requiring early surgical intervention.

The outcomes of right-sided and left-sided colonic diverticulitis following non-operative management: a systematic review and meta-analysis

“…The rate of treatment failure was 1% Kim et al [ 26 ] RCS 2008–2009 Conservative treatment with antibiotics should be the treatment of choice for right-sided diverticulitis which had a recurrence rate of 13% Park et al [ 27 ] PCS 2007–2009 Outpatient management for uncomplicated right-sided diverticulitis had a similar recurrence rate compared with inpatient management (10% vs 11%, p = NS * ). No treatment failure was noted in both groups Park et al [ 20 ] PCS 2004–2012 The recurrence rate for medical treatment of right-sided diverticulitis was 19%; of those, diverticula located only in the right colon and a single diverticulum had a lower recurrence rate Park et al [ 19 ] RCS 2017–2019 In medical treatment for right-sided diverticulitis, 9% ended up with treatment failure. Elderly (Age > 50), recurrent episodes, and elevated C-reactive protein levels are factors associated with treatment failure.…”

“…Ten studies reported the details of antibiotic treatment: 7 with 2nd or 3rd generation of cephalosporin plus metronidazole [ 19 , 23 , 27 , 28 , 31 , 33 , 34 ] and 3 with adding aminoglycoside [ 22 , 26 , 36 ]. The duration ranged from 1 to 14 days.…”

“…The risk factors related to failure in non-operative management were limited. Park et al reported that elderly (age > 50 years), recurrent episodes, and elevated C-reactive protein levels were risk factors of failure in conservative treatment [ 19 ]. Multiple diverticula were also related to the treatment failure [ 34 ].…”

“…Although the patients with right-sided CD were younger and had male predominance in our study, as those in a current meta-analysis [ 10 ], age and sex were not associated with the recurrence. The risk factors for recurrence were reported in 9 included studies [ 8 , 9 , 19 , 20 , 33 , 46 , 49 , 50 ], however, the evidence was scarce and disperse. Radiographic characteristics (e.g.…”

“…A total of 3,931 patients were included and most of them were from the eastern population [8,9,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35].…”