Predictors of acute diverticulitis severity: A systematic review

Tan, James Peng Lung; Barazanchi, Ahmed; Singh, Pushpendra; Hill, Andrew; MacCormick, Andrew D.

doi:10.1016/j.ijsu.2016.01.005

Cited by 64 publications

(46 citation statements)

References 36 publications

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“…Four studies reported on CRP level as a risk factor for complicated diverticulitis [ 15 , 16 , 18 , 20 ]. All studies found a significant effect of CRP level on the risk of complicated diverticulitis.…”

Section: Resultsmentioning

confidence: 99%

Risk factors for complicated diverticulitis: systematic review and meta-analysis

Bolkenstein

Wall

Consten

et al. 2017

Int J Colorectal Dis

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Purpose The aim of this systematic review is to identify risk factors that can predict complicated diverticulitis. Uncomplicated diverticulitis is a self-limiting and mild disease, but 10% of patients with diverticulitis develop complications requiring further treatment. It is important to estimate the risk of developing complicated diverticulitis at an early stage to set the right treatment at initial presentation. Methods Embase, MEDLINE, and Cochrane databases were searched for studies reporting on risk factors for complicated diverticulitis. Complicated diverticulitis was defined as Hinchey ≥Ib or severe diverticulitis according to the Ambrosetti criteria. Meta-analyses were performed when at least four studies reported on the outcome of interest. This study was conducted according to the PRISMA guidelines. Results A total of 12 studies were included with a total of 4619 patients. Most were of reasonable quality. Only the risk factors Bage^and Bsex^were eligible for meta-analysis, but none showed a significant effect on the risk for complicated diverticulitis. There was reasonable quality of evidence suggesting that high C-reactive protein; white blood cell count; clinical signs including generalized abdominal pain, constipation and vomiting; steroid usage; a primary episode; and comorbidity are risk factors for complicated diverticulitis.Conclusion Although high-level evidence is lacking, this study identified several risk factors associated with complicated diverticulitis. Individually, these risk factors have little value in predicting the course of diverticulitis. The authors propose a prognostic model combining these risk factors which might be the next step to aid the physician in predicting the course of diverticulitis and setting the right treatment at initial presentation.

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Section: Resultsmentioning

confidence: 99%

Risk factors for complicated diverticulitis: systematic review and meta-analysis

Bolkenstein

Wall

Consten

et al. 2017

Int J Colorectal Dis

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“…For example, in a meta-analysis of 23 studies of patients with clinical suspicion for acute appendicitis, the pooled sensitivity of leukocytosis for the diagnosis of acute appendicitis was 0.79 (95% confidence interval 0.78 to 0.81) and pooled specificity was 0.55 (0.54 to 0.57) 88. In a recent systematic review including five studies on the diagnostic value of WBC in acute diverticulitis, WBC could not be reliably used to predict the severity of acute diverticulitis or the need for surgery 89. Similarly, available data suggest that leukocytosis is not sufficiently specific to be used to differentiate bowel strangulation or mesenteric ischemia from other causes of acute abdominal pain 52536566749091.…”

Section: Laboratory Measuresmentioning

confidence: 99%

Secondary peritonitis: principles of diagnosis and intervention

Ross

Matthay

Harris

2018

BMJ

113

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Secondary peritonitis accounts for 1% of urgent or emergent hospital admissions and is the second leading cause of sepsis in patients in intensive care units globally. Overall mortality is 6%, but mortality rises to 35% in patients who develop severe sepsis. Despite the dramatic growth in the availability and use of imaging and laboratory tests, the rapid diagnosis and early management of peritonitis remains a challenge for physicians in emergency medicine, surgery, and critical care. In this article, we review the pathophysiology of peritonitis and its potential progression to sepsis, discuss the utility and limitations of the physical examination and laboratory and radiographic tests, and present a paradigm for the management of secondary peritonitis.

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“…Not only immunocompromised status, but also various underlying disorders have been proposed as a predictive factor of severity. 17 However, we evaluated only immunocompromised status, including glucocorticoid in this study. We note that our study exclusively evaluated patients with ACD.…”

Section: Discussionmentioning

confidence: 99%

“…16 According to the previously reported predictors of severe diverticulitis, we also reviewed the use of non-steroidal antiinflammatory drugs, past episodes of diverticulitis, and serum Creactive protein for adjustment of confounding due to severity. 17 We also evaluated blood culture results if submitted.…”

Section: Study Variablesmentioning

confidence: 99%

Reactive leukocytosis in older patients with acute colonic diverticulitis: A retrospective study utilizing logistic regression analysis

Sasaki

Komatsu

Kashima

et al. 2020

Geriatrics Gerontology Int

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Aim: Although various neutrophilic immunosenescence mechanisms have been shown, there are few clinical studies on age-related differences in leukocytosis against acute bacterial infections, including acute colonic diverticulitis. Methods: We performed a retrospective study of 26 patients ≥65 years old and 211 patients 16-64 years old who were hospitalized for acute colonic diverticulitis at Toho University Medical Center Omori Hospital between 2010 and 2016. We compared patients' characteristics, including sex, immunocompromised status, diverticulitis site, complications, severity, previous diverticulitis, vital signs, leukocyte counts, neutrophil-to-lymphocyte ratio and serum C-reactive protein on admission. To adjust for confounding factors, we performed a logistic regression analysis. Results: Univariate comparisons showed that leukocyte count (older: 10 850 [interquartile range, 9400-12 000]/mm 3 vs. younger: 12 600 [interquartile range, 10 500-15 000]/mm 3 , P = 0.004) and prevalence of leukocytosis (leukocytes >11 000/mm 3) were lower in older compared with younger patients. There were significantly more female, left-sided diverticulitis and immunocompromised patients in the older compared with the younger group. Logistic regression showed that leukocyte count, prevalence of female patients, and left-sided diverticulitis were independent predictors for the older patients: Their odds ratios were 0.866 (95% confidence interval [95% CI] 0.753-0.996), 2.631 (95% CI, 1.032-6.707) and 5.810 (95% CI, 2.328-14.497), respectively. Conclusion: Caution should be taken when managing older patients with colonic diverticulitis because reactive leukocytosis might be poor, possibly reflecting immunosenescence.

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Predictors of acute diverticulitis severity: A systematic review

Cited by 64 publications

References 36 publications

Risk factors for complicated diverticulitis: systematic review and meta-analysis

Risk factors for complicated diverticulitis: systematic review and meta-analysis

Secondary peritonitis: principles of diagnosis and intervention

Reactive leukocytosis in older patients with acute colonic diverticulitis: A retrospective study utilizing logistic regression analysis

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