The role of C-reactive protein in prediction of the severity of acute diverticulitis in an emergency unit

Mäkelä, Jyrki; Klintrup, Kai; Takala, Heikki; Rautio, Tero

doi:10.3109/00365521.2014.999350

Cited by 62 publications

(62 citation statements)

References 25 publications

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“…ROC curve analysis to assess CRP in the diagnostics of acute colonic diverticulitis has previously been reported with an AUC ranging from 0.72 to 0.94 [8, 30–34], which is comparable to the present results. Furthermore, these studies confirm WBC count and body temperature to be without discriminative power in distinguishing diverticulitis from other patients with acute abdominal pain, with an AUC between 0.54 and 0.57 [8, 33].…”

Section: Discussionsupporting

confidence: 91%

Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis

Talabani

Endreseth

Lydersen

et al. 2016

Int J Colorectal Dis

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PurposeThe study investigated the capability of clinical findings, temperature, C-reactive protein (CRP), and white blood cell (WBC) count to discern patients with acute colonic diverticulitis from all other patients admitted with acute abdominal pain.MethodsThe probability of acute diverticulitis was assessed by the examining doctor, using a scale from 0 (zero probability) to 10 (100 % probability). Receiver operating characteristic (ROC) curves were used to assess the clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain.ResultsOf 833 patients admitted with acute abdominal pain, 95 had acute colonic diverticulitis. ROC curve analysis gave an area under the ROC curve (AUC) of 0.95 (CI 0.92 to 0.97) for ages <65 years, AUC = 0.86 (CI 0.78 to 0.93) in older patients. Separate analysis showed an AUC = 0.83 (CI 0.80 to 0.86) of CRP alone. White blood cell count and temperature were almost useless to discriminate acute colonic diverticulitis from other types of acute abdominal pain, AUC = 0.59 (CI 0.53 to 0.65) for white blood cell count and AUC = 0.57 (0.50 to 0.63) for temperature, respectively.ConclusionThis prospective study demonstrates that standard clinical evaluation by non-specialist doctors based on history, physical examination, and initial blood tests on admission provides a high degree of diagnostic precision in patients with acute colonic diverticulitis.

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Section: Discussionsupporting

confidence: 91%

Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis

Talabani

Endreseth

Lydersen

et al. 2016

Int J Colorectal Dis

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“…If the in ammation index is not high, the patient can recover quickly without special treatment. MÄKELÄ et al published a study showing that CRP > 150 mg/L is an independent risk factor for colonic diverticulitis [7]. In our study, the proportion of patients with CRP > 150 mg/L was relatively low.…”

Section: Discussioncontrasting

confidence: 48%

Characteristics of predominantly right-sided colonic diverticulitis without need for colectomy

Chen

Zhang

Wu³

et al. 2020

Preprint

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Background: In China, diverticulitis is more often located in the right colon, mainly in the cecum and ascending colon. Here we study the characteristics of acute colonic diverticulitis and compare various treatments for acute right-sided colonic diverticulitis.Methods: A retrospective analysis of 123 patients with acute colonic diverticulitis treated in our hospital from April 2013 to April 2020, including 114 cases of right-sided colonic diverticulitis, was performed. The characteristics of acute colonic diverticulitis were analyzed, and the therapeutic effects of different treatments for acute right-sided colonic diverticulitis were compared.Results: 111 cases of caecal and ascending colonic diverticulitis were identified (90.2% of cases, male to female ratio 2.26:1, average age 39.6 ± 14.4 years, surgery ratio 24.3%, mean hospital stay 7.4 ± 4.3 days, recurrence rate 3.6%). Three cases of transverse colonic diverticulitis and three cases of descending colonic diverticulitis were found. Six cases of Sigmoid diverticulitis (4.9% of cases, male to female ratio 1:1, average age 67.7 ± 4.5 years, surgery ratio 33.3%, mean hospital stay 11.7 ± 5.5 days, recurrence rate 0%) were found. 13 patients underwent right-sided colonic diverticulitis resection and repair, while zero patients underwent colectomy. Abdominal drainage was performed in 15 patients with right-sided colonic diverticulitis. There was no significant difference in the length of hospital stay among the three treatments for right-sided colonic diverticulitis (P = 0.05). There was no significant difference in the recurrence rate among the three treatments of right-sided colonic diverticulitis ( P = 0.358). While the recurrence rate of right-sided colonic diverticulitis was only 3.5%, relapse usually occurred within the first year following treatment.Conclusions: In our patients, right-sided colonic diverticulitis is more common in young and middle-aged patients than in elderly patients and we see a higher incidence in males. Acute right-sided complex diverticulitis is rare. While non-surgical treatment is preferred for acute right-sided uncomplicated diverticulitis, no significant difference in outcome was observed between the three different treatments we compared. Resection and repair of diverticulum or abdominal drainage can also be used to treat patients with acute uncomplicated diverticulitis.

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“…Studies have shown that certain elevated inflammatory markers may have potential use in differentiating between complicated and uncomplicated cases, yet their exact role is yet to be defined. (14)(15)(16)(17)(18)(19)(20)(21) Table 3 demonstrates recent studies that have been conducted and the findings of significance for the biochemical marker tested.…”

Section: Discussionmentioning

confidence: 99%

“…(11)(12)(13) Many researchers (Makela, Van de Wal, Longstreth) have investigated the efficacy of biochemical inflammatory markers in the diagnosis of acute diverticulitis. (14)(15)(16)Leukocytosis has been demonstrated to be more prevalent in severe cases of diverticulitis, (16) with white cell count (WBC) shown to be significantly higher in complicated vs uncomplicated diverticulitis. (15,17,18) Similarly, C-reactive protein (CRP) has been shown as a useful supporting tool in diagnosing the clinical severity of acute diverticulitis.…”

Section: Introductionmentioning

confidence: 99%

“…(15,17,18) Similarly, C-reactive protein (CRP) has been shown as a useful supporting tool in diagnosing the clinical severity of acute diverticulitis. (14,(18)(19)(20)(21) Among other markers hyperbilirubinemia, although having a low sensitivity, has been shown to have a high specificity and positive predictive value for perforation in acute diverticulitis and may be a focus for future research. (18) Although most studies have indicated trends for the WCC and CRP to be higher in complicated diverticulitis, specific values to be used with diagnostic reliability have varied widely.…”

Section: Introductionmentioning

confidence: 99%

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The Use of Biochemical Markers in Complicated and Uncomplicated Acute Diverticulitis

Kumarasinghe

Zahid

O’Grady

et al. 2018

International Surgery

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Abstract:Abstract BACKGROUND: Diverticulosis is extremely common in western society. A recent study has shown that outpatient, non-antibiotic management of acute uncomplicated diverticulitis may be a feasible and safe option. However the ability to identify these patients is still difficult. This study explores the ability of white cell count, C-reactive protein and bilirubin in differentiating patients with complicated and uncomplicated diverticulitis as well as progression to surgical intervention. METHODS: This is a retrospective study of patients admitted with acute diverticulitis over a 5-year period (2009)(2010)(2011)(2012)(2013)(2014) at a single institution in Australia. Patients were classified into three groups; uncomplicated diverticulitis, complicated diverticulitis without surgery and complicated diverticulitis with surgery. ANOVA and Bonferroni's post-hoc analyses were used to compare markers across the groups. RESULTS: A total of 541 patients met the inclusion criteria for this study. One-way ANOVA showed a significant difference in white cell count (p<0.0001), C-reactive protein (p<0.0001) and bilirubin (p=0.0006) between all three groups. Post-hoc analyses showed a significant difference in white cell count, C-reactive protein and bilirubin when comparing uncomplicated diverticulitis against complicated diverticulitis without surgery (p<0.05) and complicated diverticulitis with surgery (p<0.05). White cell count also showed a significant difference when comparing complicated diverticulitis without surgery and complicated diverticulitis with surgery (p<0.05). CONCLUSIONS: White cell count, C-reactive protein and bilirubin can distinguish between uncomplicated and complicated diverticulitis.

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The role of C-reactive protein in prediction of the severity of acute diverticulitis in an emergency unit

Abstract: CRP is useful for the predicting the severity of acute diverticulitis on admission. Patients with a CRP value higher than 150 mg/l have an in increased risk of complicated diverticulitis and a CT examination should always be carried out.

Cited by 62 publications

References 25 publications

Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis

Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis

Characteristics of predominantly right-sided colonic diverticulitis without need for colectomy

The Use of Biochemical Markers in Complicated and Uncomplicated Acute Diverticulitis

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