Choroba uchyłkowa jelit i zapalenie uchyłków – Rokowania, prognozy i postęp choroby

Choroba uchyłkowa jelit i zapalenie uchyłków
Rokowania, prognozy i postęp choroby

Choroba uchyłkowa jelit dotyka około 70% populacji zachodniej do 80. roku życia, z 80-85% pacjentów pozostających bezobjawowymi. Ostre zapalenie uchyłków (diverticulitis) rozwija się u około 5% chorych, z 15-25% z nich doświadczających powikłań wymagających interwencji chirurgicznej. Ryzyko nawrotu po pierwszym epizodzie wynosi około 20% w ciągu 5 lat, a u pacjentów leczonych zachowawczo wzrasta do 20-35%. Powikłane zapalenie uchyłków, obejmujące ropnie, perforacje, przetoki i krwawienia, występuje u około 12% pacjentów z ostrym zapaleniem, z największą śmiertelnością w przypadku perforacji i ropni. Ropień o średnicy >3 cm zwiększa ryzyko niepowodzenia leczenia zachowawczego (13,9-20%). Skala PACO-D, uwzględniająca m.in. płeć męską, zaparcia, hemoglobinę ≤11,9 g/dL, CRP ≥80 mg/mL, otyłość i brak inhibitorów pompy protonowej, pozwala na identyfikację pacjentów z wysokim ryzykiem powikłań, wykazując AUC 0,674 i 0,648 w kohortach retrospektywnej i prospektywnej.

Choroba uchyłkowa jelit i zapalenie uchyłków – rokowanie (prognoza końcowa)

Rokowanie w chorobie uchyłkowej jelit i zapaleniu uchyłków zależy od wielu czynników, w tym nasilenia choroby, występowania powikłań oraz współistniejących problemów zdrowotnych. Choroba uchyłkowa (diverticulosis) dotyka około 70% populacji zachodniej do 80 roku życia, jednak większość przypadków pozostaje bezobjawowa. ¹²

Wśród pacjentów z uchyłkami jelita, 80-85% pozostaje bezobjawowych przez całe życie. Jedynie około 5% rozwinie ostre zapalenie uchyłków (diverticulitis), a 15-25% tych pacjentów doświadczy powikłań wymagających interwencji chirurgicznej. ³

Ryzyko nawrotu choroby

Choroba uchyłkowa ma tendencję do nawrotów. Po pierwszym epizodzie ostrego zapalenia uchyłków, 5-letnie ryzyko nawrotu wynosi około 20%. ⁴⁵ U pacjentów leczonych zachowawczo (bez operacji) wskaźnik nawrotów wzrasta do 20-35%. ⁶ Badanie obejmujące 252 pacjentów wykazało nawet 47% nawrotów po 7 latach. ⁷

Ryzyko nawrotu wzrasta z każdym kolejnym epizodem: 18% w ciągu roku po drugim epizodzie i 40% w ciągu 3 lat po trzecim epizodzie. ⁸ Co istotne, większość powikłań związanych z zapaleniem uchyłków występuje podczas pierwszego epizodu, a ryzyko powikłań zmniejsza się przy kolejnych epizodach. ⁹

Powikłane zapalenie uchyłków i jego prognostyczne znaczenie

Powikłane zapalenie uchyłków, definiowane jako obecność ropnia, zapalenia otrzewnej, niedrożności, przetoki lub krwawienia, wiąże się ze znaczną chorobowością i śmiertelnością. ¹⁰ Powikłania występują u około 12% pacjentów z ostrym zapaleniem uchyłków, przy czym najwyższa śmiertelność dotyczy pacjentów z perforacją lub ropniami. ¹¹

Najczęstszymi powikłaniami są:

Ropień okołookrężniczy (~70% przypadków powikłań) ¹²
Perforacja okrężnicy z ropnym lub kałowym zapaleniem otrzewnej (~27%) ¹³
Przetoka (~14%) ¹⁴
Krwawienie uchyłkowe (5-15% pacjentów) ¹⁵

W przypadku ropni uchyłkowych, średnica ropnia większa niż 3 cm jest uznanym czynnikiem ryzyka niepowodzenia leczenia zachowawczego. Wskaźnik niepowodzenia początkowego leczenia zachowawczego waha się między 13,9% a 20%. ¹⁶

Czynniki predykcyjne ciężkiego przebiegu zapalenia uchyłków

Wczesna identyfikacja pacjentów z wysokim ryzykiem powikłanego zapalenia uchyłków ma kluczowe znaczenie, szczególnie dla lekarzy oddziałów ratunkowych. ¹⁷ W odpowiedzi na tę potrzebę opracowano skalę predykcyjną PACO-D, która pomaga identyfikować pacjentów o najwyższym ryzyku powikłanego zapalenia uchyłków. ¹⁸

Skala PACO-D

W analizie wieloczynnikowej regresji logistycznej, następujące czynniki pozostawały istotnie powiązane z powikłanym zapaleniem uchyłków:

Płeć męska ¹⁹
Zaparcia ²⁰
Poziom hemoglobiny ≤11,9 g/dL ²¹
CRP ≥80 mg/mL ²²
Otyłość ²³
Brak stosowania inhibitorów pompy protonowej ²⁴

Skala PACO-D klasyfikuje pacjentów do trzech grup ryzyka powikłanego zapalenia uchyłków. Pacjenci z grupy wysokiego ryzyka wykazują ośmiokrotnie większe ryzyko powikłanego zapalenia uchyłków i sześciokrotnie większe ryzyko poważnych powikłań w porównaniu z grupą niskiego ryzyka. ²⁵ Skala ta wykazała umiarkowaną zdolność dyskryminacyjną dla powikłanego zapalenia uchyłków z polem pod krzywą ROC wynoszącym 0,674 i 0,648, odpowiednio w kohortach retrospektywnej i prospektywnej. ²⁶

Wpływ zaburzeń wypróżnień na przebieg choroby

Badania prospektywne wykazały, że zarówno zaparcia, jak i biegunka są niezależnymi czynnikami prognostycznymi ostrego zapalenia uchyłków. ²⁷ Wyższe wyniki w skali zaparć i biegunki wiązały się z cięższym przebiegiem choroby uchyłkowej. ²⁸

Trzyletnie skumulowane prawdopodobieństwo rozwoju zapalenia uchyłków wyniosło 5,9% (95% CI, 4,1%-8,3%) u pacjentów bez objawów zaparć i 10,0% (95% CI, 7,0%-13,7%) u pacjentów z objawami zaparć, co stanowi statystycznie istotną różnicę (test log-rank, P=0,03). ²⁹ Oznacza to, że nie tylko ciężkość zaparć lub biegunki u pacjentów z chorobą uchyłkową jest związana z ciężkością choroby, ale także wzrost nasilenia zaparć lub biegunki zwiększa ryzyko ostrego zapalenia uchyłków. ³⁰

Różnice geograficzne w czynnikach ryzyka

Warto zauważyć, że czynniki ryzyka ciężkiego zapalenia uchyłków mogą różnić się w zależności od regionu geograficznego. W Korei, gdzie dominuje prawostronna choroba uchyłkowa, czynnikami ryzyka rozwoju ciężkiego zapalenia uchyłków są płeć męska, wiek powyżej 40 lat i lewostronna lokalizacja uchyłków. ³¹ Te czynniki różnią się od tych obserwowanych w krajach zachodnich, co sugeruje potrzebę różnych wytycznych leczenia dla pacjentów z azjatycką chorobą uchyłkową. ³²

Wyniki leczenia i jakość życia

Ostre zapalenie uchyłków jest niepowikłane w 80% przypadków. ³³ Tylko niewielki odsetek pacjentów będzie miał powikłane zapalenie uchyłków, a jeszcze mniejszy odsetek będzie wymagał operacji. ³⁴

Wpływ leczenia na jakość życia

Elektywna sigmoidektomia w przypadku nawracającego niepowikłanego zapalenia uchyłków pozostaje kontrowersyjna i jest decydowana indywidualnie. ³⁵ Badania porównujące jakość życia związaną ze zdrowiem (HR-QOL) u pacjentów poddawanych leczeniu nieoperacyjnemu lub elektywnej resekcji wykazały, że ogólna jakość życia była lepsza u pacjentów po operacji, chociaż różnica ta nie osiągnęła istotności statystycznej. ³⁶

Co ciekawe, fizyczne i emocjonalne wyniki HR-QOL u pacjentek poddawanych laparoskopowej resekcji były statystycznie znacząco lepsze niż u kobiet leczonych zachowawczo. ³⁷ Dane sugerują, że laparoskopowa resekcja w przypadku nawracającego niepowikłanego zapalenia uchyłków jest ważną opcją poprawy jakości życia, szczególnie u kobiet. ³⁸

Rozważania dotyczące leczenia

W przypadku ropni uchyłkowych, zarówno terapia antybiotykowa, jak i drenaż przezskórny są wykonalnymi i bezpiecznymi opcjami w leczeniu większych ropni, z podobnymi wynikami okołooperacyjnymi i powikłaniami pooperacyjnymi. ³⁹ U pacjentów poddawanych operacji z powodu ropnia uchyłkowego, ryzyko wytworzenia stomii wzrasta wraz z wyższym BMI. ⁴⁰

Elektywna operacja powinna być decydowana indywidualnie, a nie na podstawie liczby epizodów. ⁴¹ Warto podkreślić, że skala PACO-D powinna być traktowana jako narzędzie wspomagające tomografię komputerową jamy brzusznej, która pozostaje niezbędna nie tylko do potwierdzenia diagnozy powikłanego zapalenia uchyłków, ale przede wszystkim do zaplanowania dalszego leczenia. ⁴²

Długoterminowe rokowanie

W większości przypadków, nawet powikłane zapalenie uchyłków szybko i całkowicie ustępuje po leczeniu. ⁴³ Choroba uchyłkowa nie powinna wpływać na ogólną oczekiwaną długość życia. Jedynie w mało prawdopodobnym przypadku perforacji jelita lub pęknięcia ropnia istniałoby ryzyko zagrażających życiu powikłań. ⁴⁴

Należy jednak pamiętać, że młodsi pacjenci z zapaleniem uchyłków mogą mieć cięższą postać choroby, potencjalnie z powodu opóźnienia w diagnozie i leczeniu. Pacjenci z obniżoną odpornością mają znacznie wyższą chorobowość i śmiertelność z powodu zapalenia uchyłków esicy. ⁴⁵

Przewlekłe objawy związane z chorobą uchyłkową, w tym objętościowa choroba uchyłkowa (SUDD) i zgłaszane objawy podobne do zespołu jelita drażliwego, są trudne do opanowania i stanowią znaczne obciążenie dla opieki zdrowotnej. ⁴⁶

Wpływ ekonomiczny choroby uchyłkowej

Obciążenie ekonomiczne chorobą uchyłkową rośnie, z raportowanym rocznym kosztem 5,5 miliarda dolarów w USA w 2019 roku. ⁴⁷ W ostatnich dwóch dekadach, szczególnie w krajach zachodnich, częstość występowania i wskaźnik hospitalizacji z powodu ostrego zapalenia uchyłków i jego powikłań stopniowo wzrastały, co stanowi znaczne obciążenie dla krajowych systemów opieki zdrowotnej. ⁴⁸

Jak oczekiwano, śmiertelność wewnątrzszpitalna, poważne powikłania, operacje, drenaż przezskórny i umieszczenie kolostomii były znacznie częstsze u pacjentów z powikłanym zapaleniem uchyłków. ⁴⁹ Te dane dotyczące chorobowości i śmiertelności, a także wskaźniki nawrotów, opierają się na retrospektywnym przeglądzie stosunkowo krótkoterminowych danych. ⁵⁰

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Materiały źródłowe

#1 Diverticular disease: update on pathophysiology, classification and management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10935533/
Colonic diverticulosis is prevalent, affecting approximately 70% of the western population by 80 years of age. […] Between 10% and 25% of those with diverticular disease (DD) will experience acute diverticulitis. A further 15% will develop complications including abscess, bleeding and perforation. Such complications are associated with significant morbidity and mortality and constitute a worldwide health burden. […] The cost burden of DD is rising with a reported annual cost of US$5.5 billion in the USA in 2019. […] The most common complication of DD is acute diverticulitis, which is defined as DD with signs and symptoms of diverticular inflammation. […] Complicated diverticulitis most frequently involves a pericolonic abscess (~70%), followed by colonic perforation with purulent or faecal peritonitis (~27%), followed by fistula (~14%).
#2 Diverticulitis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/173388-overview
The prognosis in patients with diverticulitis depends on the severity of the illness, the presence of complications, and the presence of any coexisting medical problems. Younger patients with diverticulitis may have more severe disease, possibly due to a delay in the diagnosis and treatment. Immunosuppressed patients have significantly higher morbidity and mortality due to sigmoid diverticulitis. […] Of the patients who have diverticulosis, 80%-85% remain asymptomatic. Approximately 5% develop diverticulitis; 15%-25% of those with diverticulitis develop complications that lead to surgical intervention. These complications include abscess formation, intestinal rupture, peritonitis, and fistula formation. […] Diverticulitis may be a more severe illness in those who are immunocompromised, who have significant comorbid conditions, and in those taking anti-inflammatory medications. Note the following: After a first occurrence of acute diverticulitis, the 5-year recurrence rate is 20%.
#3 Diverticulitis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/173388-overview
The prognosis in patients with diverticulitis depends on the severity of the illness, the presence of complications, and the presence of any coexisting medical problems. Younger patients with diverticulitis may have more severe disease, possibly due to a delay in the diagnosis and treatment. Immunosuppressed patients have significantly higher morbidity and mortality due to sigmoid diverticulitis. […] Of the patients who have diverticulosis, 80%-85% remain asymptomatic. Approximately 5% develop diverticulitis; 15%-25% of those with diverticulitis develop complications that lead to surgical intervention. These complications include abscess formation, intestinal rupture, peritonitis, and fistula formation. […] Diverticulitis may be a more severe illness in those who are immunocompromised, who have significant comorbid conditions, and in those taking anti-inflammatory medications. Note the following: After a first occurrence of acute diverticulitis, the 5-year recurrence rate is 20%.
#4 Diverticulitis: Symptoms, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/10352-diverticulitis
Diverticulitis is an uncommon complication. […] Once you’ve had it, you have a 20% chance of getting it again. […] Diverticulitis is uncomplicated 80% of the time. […] Only a small percentage of people will have complicated diverticulitis, and only a small percentage of those will need surgery. […] In most cases, even complicated diverticulitis resolves quickly and completely with treatment. […] Diverticulitis shouldn’t affect your overall life expectancy. Only in the unlikely event of a bowel perforation or a ruptured abscess would you be at risk of life-threatening complications.
#5 Diverticulitis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/173388-overview
The prognosis in patients with diverticulitis depends on the severity of the illness, the presence of complications, and the presence of any coexisting medical problems. Younger patients with diverticulitis may have more severe disease, possibly due to a delay in the diagnosis and treatment. Immunosuppressed patients have significantly higher morbidity and mortality due to sigmoid diverticulitis. […] Of the patients who have diverticulosis, 80%-85% remain asymptomatic. Approximately 5% develop diverticulitis; 15%-25% of those with diverticulitis develop complications that lead to surgical intervention. These complications include abscess formation, intestinal rupture, peritonitis, and fistula formation. […] Diverticulitis may be a more severe illness in those who are immunocompromised, who have significant comorbid conditions, and in those taking anti-inflammatory medications. Note the following: After a first occurrence of acute diverticulitis, the 5-year recurrence rate is 20%.
#6 Diverticulitis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/173388-overview
Patients with diverticulitis who are managed conservatively (ie, do not undergo surgery) have a recurrence rate of 20%-35%. […] In a study of 252 patients, a 47% recurrence rate was reported after 7 years. […] Another study of 337 patients hospitalized for complicated diverticulitis revealed an association of perforation and mortality in those without a prior history of diverticulitis. […] These morbidity and mortality data, as well as the recurrence rates, are based on a retrospective review of relatively short-term data. […] Many studies have demonstrated the significant association between obesity and the risk of developing diverticulitis.
#7 Diverticulitis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/173388-overview
Patients with diverticulitis who are managed conservatively (ie, do not undergo surgery) have a recurrence rate of 20%-35%. […] In a study of 252 patients, a 47% recurrence rate was reported after 7 years. […] Another study of 337 patients hospitalized for complicated diverticulitis revealed an association of perforation and mortality in those without a prior history of diverticulitis. […] These morbidity and mortality data, as well as the recurrence rates, are based on a retrospective review of relatively short-term data. […] Many studies have demonstrated the significant association between obesity and the risk of developing diverticulitis.
#8 Diverticular disease: update on pathophysiology, classification and management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10935533/
Diverticular haemorrhage is a frequent complication that occurs in 5%15% of patients. […] The risk of complications decreases with further episodes. […] There is an overall 20% risk of recurrence with 8% experiencing a further attack within the first year. Rate of recurrence increases following additional episodes: 18% at 1 year following a second episode and 40% at 3 years after a third episode. […] Elective surgery should be decided on a case-by-case basis, not by number of episodes. […] Most complications related to diverticulitis occur during the primary episode. […] Chronic symptoms associated with DD including SUDD and the reported IBS-like symptoms are difficult to manage and present a significant healthcare burden.
#9 Diverticular disease: update on pathophysiology, classification and management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10935533/
Diverticular haemorrhage is a frequent complication that occurs in 5%15% of patients. […] The risk of complications decreases with further episodes. […] There is an overall 20% risk of recurrence with 8% experiencing a further attack within the first year. Rate of recurrence increases following additional episodes: 18% at 1 year following a second episode and 40% at 3 years after a third episode. […] Elective surgery should be decided on a case-by-case basis, not by number of episodes. […] Most complications related to diverticulitis occur during the primary episode. […] Chronic symptoms associated with DD including SUDD and the reported IBS-like symptoms are difficult to manage and present a significant healthcare burden.
#10 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://pmc.ncbi.nlm.nih.gov/articles/PMC7911244/
The prevalence of acute diverticulitis (AD) has progressively increased in recent decades, with correspondingly greater morbidity and mortality. […] The aim of the study is to develop a predictive score to identify patients with the highest risk of complicated AD. […] The PACO-D score could be a practical clinical tool to identify patients at highest risk for complicated AD referred to the ED so that appropriate diagnostic and therapeutic resources could be appropriately allocated. […] Indeed, complicated AD, as defined by the presence of any of the following manifestations: abscess, peritonitis, obstruction, fistula, or hemorrhage, is burdened with considerable morbidity and mortality. […] Therefore, early identification of patients at the highest risk of complicated AD would be of great benefit, particularly for emergency department (ED) physicians.
#11 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://www.mdpi.com/2075-4426/11/2/80
The PACO-D score showed fair discrimination for complicated AD with an area under the receiver operating characteristic curve of 0.674 and 0.648, in the retrospective and prospective cohorts, respectively. […] In the last two decades, particularly in Western countries, the prevalence and hospitalization rate of AD and its complications have progressively increased, placing a considerable burden on national health systems. […] Complications occur in approximately 12% of patients with AD, and mortality after complicated diverticulitis is highest among individuals with perforation or abscesses. […] Thus, it is extremely important to identify patients with AD who are at the highest risk of having a complicated disease and, consequently, a worse outcome. […] The PACO-D score, developed in a large sample of patients with AD and then validated in an equally large prospective cohort, may represent a useful prognostic model in the management of patients with AD referred to the ED.
#12 Diverticular disease: update on pathophysiology, classification and management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10935533/
Colonic diverticulosis is prevalent, affecting approximately 70% of the western population by 80 years of age. […] Between 10% and 25% of those with diverticular disease (DD) will experience acute diverticulitis. A further 15% will develop complications including abscess, bleeding and perforation. Such complications are associated with significant morbidity and mortality and constitute a worldwide health burden. […] The cost burden of DD is rising with a reported annual cost of US$5.5 billion in the USA in 2019. […] The most common complication of DD is acute diverticulitis, which is defined as DD with signs and symptoms of diverticular inflammation. […] Complicated diverticulitis most frequently involves a pericolonic abscess (~70%), followed by colonic perforation with purulent or faecal peritonitis (~27%), followed by fistula (~14%).
#13 Diverticular disease: update on pathophysiology, classification and management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10935533/
Colonic diverticulosis is prevalent, affecting approximately 70% of the western population by 80 years of age. […] Between 10% and 25% of those with diverticular disease (DD) will experience acute diverticulitis. A further 15% will develop complications including abscess, bleeding and perforation. Such complications are associated with significant morbidity and mortality and constitute a worldwide health burden. […] The cost burden of DD is rising with a reported annual cost of US$5.5 billion in the USA in 2019. […] The most common complication of DD is acute diverticulitis, which is defined as DD with signs and symptoms of diverticular inflammation. […] Complicated diverticulitis most frequently involves a pericolonic abscess (~70%), followed by colonic perforation with purulent or faecal peritonitis (~27%), followed by fistula (~14%).
#14 Diverticular disease: update on pathophysiology, classification and management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10935533/
Colonic diverticulosis is prevalent, affecting approximately 70% of the western population by 80 years of age. […] Between 10% and 25% of those with diverticular disease (DD) will experience acute diverticulitis. A further 15% will develop complications including abscess, bleeding and perforation. Such complications are associated with significant morbidity and mortality and constitute a worldwide health burden. […] The cost burden of DD is rising with a reported annual cost of US$5.5 billion in the USA in 2019. […] The most common complication of DD is acute diverticulitis, which is defined as DD with signs and symptoms of diverticular inflammation. […] Complicated diverticulitis most frequently involves a pericolonic abscess (~70%), followed by colonic perforation with purulent or faecal peritonitis (~27%), followed by fistula (~14%).
#15 Diverticular disease: update on pathophysiology, classification and management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10935533/
Diverticular haemorrhage is a frequent complication that occurs in 5%15% of patients. […] The risk of complications decreases with further episodes. […] There is an overall 20% risk of recurrence with 8% experiencing a further attack within the first year. Rate of recurrence increases following additional episodes: 18% at 1 year following a second episode and 40% at 3 years after a third episode. […] Elective surgery should be decided on a case-by-case basis, not by number of episodes. […] Most complications related to diverticulitis occur during the primary episode. […] Chronic symptoms associated with DD including SUDD and the reported IBS-like symptoms are difficult to manage and present a significant healthcare burden.
#16
https://link.springer.com/article/10.1007/s00384-024-04682-z
Diverticular abscess is a common manifestation of acute complicated diverticulitis. […] Abscess diameter3 cm is not just an arbitrary chosen cut-off value for drainage placement but has a prognostic impact on medical treatment failure in patients with complicated acute diverticulitis. […] The failure rate of initial conservative management ranges between 13.9 and 20%. […] Abscess size is recognized as a predictive outcome factor following initial medical therapy. […] An abscess diameter larger than 3 cm is a predictive risk factor of non-operative treatment failure. […] Both antibiotic therapy and percutaneous drainage are feasible and safe options in the management of larger abscesses with similar perioperative outcomes and postoperative complications. […] In patients undergoing surgery for diverticular abscess, the risk of overall stoma formation increases with a higher BMI.
#17 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://pmc.ncbi.nlm.nih.gov/articles/PMC7911244/
The prevalence of acute diverticulitis (AD) has progressively increased in recent decades, with correspondingly greater morbidity and mortality. […] The aim of the study is to develop a predictive score to identify patients with the highest risk of complicated AD. […] The PACO-D score could be a practical clinical tool to identify patients at highest risk for complicated AD referred to the ED so that appropriate diagnostic and therapeutic resources could be appropriately allocated. […] Indeed, complicated AD, as defined by the presence of any of the following manifestations: abscess, peritonitis, obstruction, fistula, or hemorrhage, is burdened with considerable morbidity and mortality. […] Therefore, early identification of patients at the highest risk of complicated AD would be of great benefit, particularly for emergency department (ED) physicians.
#18 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://www.mdpi.com/2075-4426/11/2/80
The prevalence of acute diverticulitis (AD) has progressively increased in recent decades, with correspondingly greater morbidity and mortality. […] The aim of the study is to develop a predictive score to identify patients with the highest risk of complicated AD. […] The PACO-D score could be a practical clinical tool to identify patients at highest risk for complicated AD referred to the ED so that appropriate diagnostic and therapeutic resources could be appropriately allocated. […] Indeed, having a reliable diagnostic tool capable of predicting the severity of AD at the initial presentation and estimating the outcome of these patients would make ED physicians more confident in focusing on the diagnostic and therapeutic efforts in complicated cases and, consequently, in the management of mild cases on an outpatient basis.
#19 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://pmc.ncbi.nlm.nih.gov/articles/PMC7911244/
Thus, the aim of this study was to develop and validate an easy-to-apply score, which includes several variables independently associated with complicated AD, in order to identify the patients at highest risk of developing complicated AD among all patients referred to the ED with a diagnosis of AD. […] In the multivariate logistic regression analysis for factors associated with complicated AD, male sex, constipation, Hb levels 11.9 g/dL, CRP 80 mg/mL, obesity, and not being on PPI remained significantly correlated with complicated AD. […] As expected, in-hospital mortality, major complications, surgery, percutaneous drainage, and colostomy placement were significantly more frequent in patients with complicated AD. […] The PACO-D score ranks patients into three risk classes for complicated AD: patients of the derivation cohort in the high-risk group showed an eight-fold greater risk of complicated AD and a six-fold greater risk of cumulative major complications than those in the low-risk group considered as reference.
#20 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://pmc.ncbi.nlm.nih.gov/articles/PMC7911244/
Thus, the aim of this study was to develop and validate an easy-to-apply score, which includes several variables independently associated with complicated AD, in order to identify the patients at highest risk of developing complicated AD among all patients referred to the ED with a diagnosis of AD. […] In the multivariate logistic regression analysis for factors associated with complicated AD, male sex, constipation, Hb levels 11.9 g/dL, CRP 80 mg/mL, obesity, and not being on PPI remained significantly correlated with complicated AD. […] As expected, in-hospital mortality, major complications, surgery, percutaneous drainage, and colostomy placement were significantly more frequent in patients with complicated AD. […] The PACO-D score ranks patients into three risk classes for complicated AD: patients of the derivation cohort in the high-risk group showed an eight-fold greater risk of complicated AD and a six-fold greater risk of cumulative major complications than those in the low-risk group considered as reference.
#21 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://pmc.ncbi.nlm.nih.gov/articles/PMC7911244/
Thus, the aim of this study was to develop and validate an easy-to-apply score, which includes several variables independently associated with complicated AD, in order to identify the patients at highest risk of developing complicated AD among all patients referred to the ED with a diagnosis of AD. […] In the multivariate logistic regression analysis for factors associated with complicated AD, male sex, constipation, Hb levels 11.9 g/dL, CRP 80 mg/mL, obesity, and not being on PPI remained significantly correlated with complicated AD. […] As expected, in-hospital mortality, major complications, surgery, percutaneous drainage, and colostomy placement were significantly more frequent in patients with complicated AD. […] The PACO-D score ranks patients into three risk classes for complicated AD: patients of the derivation cohort in the high-risk group showed an eight-fold greater risk of complicated AD and a six-fold greater risk of cumulative major complications than those in the low-risk group considered as reference.
#22 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://pmc.ncbi.nlm.nih.gov/articles/PMC7911244/
Thus, the aim of this study was to develop and validate an easy-to-apply score, which includes several variables independently associated with complicated AD, in order to identify the patients at highest risk of developing complicated AD among all patients referred to the ED with a diagnosis of AD. […] In the multivariate logistic regression analysis for factors associated with complicated AD, male sex, constipation, Hb levels 11.9 g/dL, CRP 80 mg/mL, obesity, and not being on PPI remained significantly correlated with complicated AD. […] As expected, in-hospital mortality, major complications, surgery, percutaneous drainage, and colostomy placement were significantly more frequent in patients with complicated AD. […] The PACO-D score ranks patients into three risk classes for complicated AD: patients of the derivation cohort in the high-risk group showed an eight-fold greater risk of complicated AD and a six-fold greater risk of cumulative major complications than those in the low-risk group considered as reference.
#23 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://pmc.ncbi.nlm.nih.gov/articles/PMC7911244/
Thus, the aim of this study was to develop and validate an easy-to-apply score, which includes several variables independently associated with complicated AD, in order to identify the patients at highest risk of developing complicated AD among all patients referred to the ED with a diagnosis of AD. […] In the multivariate logistic regression analysis for factors associated with complicated AD, male sex, constipation, Hb levels 11.9 g/dL, CRP 80 mg/mL, obesity, and not being on PPI remained significantly correlated with complicated AD. […] As expected, in-hospital mortality, major complications, surgery, percutaneous drainage, and colostomy placement were significantly more frequent in patients with complicated AD. […] The PACO-D score ranks patients into three risk classes for complicated AD: patients of the derivation cohort in the high-risk group showed an eight-fold greater risk of complicated AD and a six-fold greater risk of cumulative major complications than those in the low-risk group considered as reference.
#24 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://pmc.ncbi.nlm.nih.gov/articles/PMC7911244/
Thus, the aim of this study was to develop and validate an easy-to-apply score, which includes several variables independently associated with complicated AD, in order to identify the patients at highest risk of developing complicated AD among all patients referred to the ED with a diagnosis of AD. […] In the multivariate logistic regression analysis for factors associated with complicated AD, male sex, constipation, Hb levels 11.9 g/dL, CRP 80 mg/mL, obesity, and not being on PPI remained significantly correlated with complicated AD. […] As expected, in-hospital mortality, major complications, surgery, percutaneous drainage, and colostomy placement were significantly more frequent in patients with complicated AD. […] The PACO-D score ranks patients into three risk classes for complicated AD: patients of the derivation cohort in the high-risk group showed an eight-fold greater risk of complicated AD and a six-fold greater risk of cumulative major complications than those in the low-risk group considered as reference.
#25 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://pmc.ncbi.nlm.nih.gov/articles/PMC7911244/
Thus, the aim of this study was to develop and validate an easy-to-apply score, which includes several variables independently associated with complicated AD, in order to identify the patients at highest risk of developing complicated AD among all patients referred to the ED with a diagnosis of AD. […] In the multivariate logistic regression analysis for factors associated with complicated AD, male sex, constipation, Hb levels 11.9 g/dL, CRP 80 mg/mL, obesity, and not being on PPI remained significantly correlated with complicated AD. […] As expected, in-hospital mortality, major complications, surgery, percutaneous drainage, and colostomy placement were significantly more frequent in patients with complicated AD. […] The PACO-D score ranks patients into three risk classes for complicated AD: patients of the derivation cohort in the high-risk group showed an eight-fold greater risk of complicated AD and a six-fold greater risk of cumulative major complications than those in the low-risk group considered as reference.
#26 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://www.mdpi.com/2075-4426/11/2/80
The PACO-D score showed fair discrimination for complicated AD with an area under the receiver operating characteristic curve of 0.674 and 0.648, in the retrospective and prospective cohorts, respectively. […] In the last two decades, particularly in Western countries, the prevalence and hospitalization rate of AD and its complications have progressively increased, placing a considerable burden on national health systems. […] Complications occur in approximately 12% of patients with AD, and mortality after complicated diverticulitis is highest among individuals with perforation or abscesses. […] Thus, it is extremely important to identify patients with AD who are at the highest risk of having a complicated disease and, consequently, a worse outcome. […] The PACO-D score, developed in a large sample of patients with AD and then validated in an equally large prospective cohort, may represent a useful prognostic model in the management of patients with AD referred to the ED.
#27 Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study
https://www.irjournal.org/journal/view.php?number=1078
Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study. […] Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P0.001). […] Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.041.27; P=0.004; and HRdiarrhea =1.14; 95% CI, 1.031.26; P=0.014, respectively). […] In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. […] Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.
#28 Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study
https://www.irjournal.org/journal/view.php?number=1078
Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study. […] Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P0.001). […] Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.041.27; P=0.004; and HRdiarrhea =1.14; 95% CI, 1.031.26; P=0.014, respectively). […] In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. […] Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.
#29 Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study
https://www.irjournal.org/journal/view.php?number=1078
The estimated 3-year cumulative probability of diverticulitis was 5.9% (95% CI, 4.1%8.3%) in patients without symptoms of constipation (i.e., VASconstipation = 0) and 10.0% (95% CI, 7.0%13.7%) in patients with these specific symptoms (VASconstipation 0), which significantly differed across the strata (log-rank test, P=0.03). […] This means that not only the severity of constipation or diarrhea in patients with DD is associated with the severity of the disease, but also that the increase in the score of constipation or diarrhea increases the hazard of acute diverticulitis. […] In conclusion, this prospective cohort study showed that higher diarrhea and constipation scores at baseline predicted higher endoscopic (i.e., DICA) and composite (i.e., CODA) scores of DD severity and higher FC levels. Moreover, both constipation and diarrhea were independent prognostic factors of acute diverticulitis.
#30 Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study
https://www.irjournal.org/journal/view.php?number=1078
The estimated 3-year cumulative probability of diverticulitis was 5.9% (95% CI, 4.1%8.3%) in patients without symptoms of constipation (i.e., VASconstipation = 0) and 10.0% (95% CI, 7.0%13.7%) in patients with these specific symptoms (VASconstipation 0), which significantly differed across the strata (log-rank test, P=0.03). […] This means that not only the severity of constipation or diarrhea in patients with DD is associated with the severity of the disease, but also that the increase in the score of constipation or diarrhea increases the hazard of acute diverticulitis. […] In conclusion, this prospective cohort study showed that higher diarrhea and constipation scores at baseline predicted higher endoscopic (i.e., DICA) and composite (i.e., CODA) scores of DD severity and higher FC levels. Moreover, both constipation and diarrhea were independent prognostic factors of acute diverticulitis.
#31 The Clinical Factors for Predicting Severe Diverticulitis in Korea: A Comparison with Western Countries
https://www.gutnliver.org/journal/view.html?volume=6&number=1&spage=78
It is unclear whether the risk factors associated with complicated diverticulitis in Asian and Western countries are the same. […] This study suggests that the risk factors for developing SD in Korea, where right-sided diverticulitis is predominant, are the male gender, an age of more than 40 years old, and left-sided diverticulitis. […] The purpose of this study was to investigate the prognostic factors of acute diverticulitis in Korea and to identify difference from those of acute diverticulitis in Western countries. […] The result of our study demonstrated that the risk factors of SD in Korea, which are older age, male and left-sided location, are different to those of Western diverticulitis. […] Therefore, a different treatment guideline for Asian diverticulitis, where the right-sided location is predominant, seems to be required. […] In conclusion, the risk factors of SD in Korea are different from those of Western countries.
#32 The Clinical Factors for Predicting Severe Diverticulitis in Korea: A Comparison with Western Countries
https://www.gutnliver.org/journal/view.html?volume=6&number=1&spage=78
It is unclear whether the risk factors associated with complicated diverticulitis in Asian and Western countries are the same. […] This study suggests that the risk factors for developing SD in Korea, where right-sided diverticulitis is predominant, are the male gender, an age of more than 40 years old, and left-sided diverticulitis. […] The purpose of this study was to investigate the prognostic factors of acute diverticulitis in Korea and to identify difference from those of acute diverticulitis in Western countries. […] The result of our study demonstrated that the risk factors of SD in Korea, which are older age, male and left-sided location, are different to those of Western diverticulitis. […] Therefore, a different treatment guideline for Asian diverticulitis, where the right-sided location is predominant, seems to be required. […] In conclusion, the risk factors of SD in Korea are different from those of Western countries.
#33 Diverticulitis: Symptoms, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/10352-diverticulitis
Diverticulitis is an uncommon complication. […] Once you’ve had it, you have a 20% chance of getting it again. […] Diverticulitis is uncomplicated 80% of the time. […] Only a small percentage of people will have complicated diverticulitis, and only a small percentage of those will need surgery. […] In most cases, even complicated diverticulitis resolves quickly and completely with treatment. […] Diverticulitis shouldn’t affect your overall life expectancy. Only in the unlikely event of a bowel perforation or a ruptured abscess would you be at risk of life-threatening complications.
#34 Diverticulitis: Symptoms, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/10352-diverticulitis
Diverticulitis is an uncommon complication. […] Once you’ve had it, you have a 20% chance of getting it again. […] Diverticulitis is uncomplicated 80% of the time. […] Only a small percentage of people will have complicated diverticulitis, and only a small percentage of those will need surgery. […] In most cases, even complicated diverticulitis resolves quickly and completely with treatment. […] Diverticulitis shouldn’t affect your overall life expectancy. Only in the unlikely event of a bowel perforation or a ruptured abscess would you be at risk of life-threatening complications.
#35 Quality of life in uncomplicated recurrent diverticulitis: surgical vs. conservative treatment | Scientific Reports
https://www.nature.com/articles/s41598-020-67094-3
Elective sigmoid colectomy for recurrent uncomplicated diverticulitis remains controversial and is decided on an individual basis. […] Elective sigmoidectomy is a valid treatment option for recurrent uncomplicated diverticulitis in terms of quality of life. Quality of life improved most if surgery was performed laparoscopically, especially in women. […] Improvements of HR-QOL and alleviation of diverticulitis-associated symptoms therefore remain among the main indications for elective interval resection. […] The primary outcome was the patient-reported HR-QOL measured with the adapted Gastrointestinal Quality of Life Index (aGIQLI). […] In this comparison of HR-QOL between patients undergoing non-operative management or elective resection for recurrent uncomplicated diverticulitis, we found that overall quality of life was better in patients after surgery, although this difference did not reach statistical significance.
#36 Quality of life in uncomplicated recurrent diverticulitis: surgical vs. conservative treatment | Scientific Reports
https://www.nature.com/articles/s41598-020-67094-3
Elective sigmoid colectomy for recurrent uncomplicated diverticulitis remains controversial and is decided on an individual basis. […] Elective sigmoidectomy is a valid treatment option for recurrent uncomplicated diverticulitis in terms of quality of life. Quality of life improved most if surgery was performed laparoscopically, especially in women. […] Improvements of HR-QOL and alleviation of diverticulitis-associated symptoms therefore remain among the main indications for elective interval resection. […] The primary outcome was the patient-reported HR-QOL measured with the adapted Gastrointestinal Quality of Life Index (aGIQLI). […] In this comparison of HR-QOL between patients undergoing non-operative management or elective resection for recurrent uncomplicated diverticulitis, we found that overall quality of life was better in patients after surgery, although this difference did not reach statistical significance.
#37 Quality of life in uncomplicated recurrent diverticulitis: surgical vs. conservative treatment | Scientific Reports
https://www.nature.com/articles/s41598-020-67094-3
Overall, physical and emotional HR-QOL scores in female patients undergoing laparoscopic resection were statistically significantly better than in women who were treated conservatively. […] Our data suggest that laparoscopic resection for recurrent uncomplicated diverticulitis is a valid option to improve quality of life with high patient satisfaction, especially in women undergoing laparoscopic resection.
#38 Quality of life in uncomplicated recurrent diverticulitis: surgical vs. conservative treatment | Scientific Reports
https://www.nature.com/articles/s41598-020-67094-3
Overall, physical and emotional HR-QOL scores in female patients undergoing laparoscopic resection were statistically significantly better than in women who were treated conservatively. […] Our data suggest that laparoscopic resection for recurrent uncomplicated diverticulitis is a valid option to improve quality of life with high patient satisfaction, especially in women undergoing laparoscopic resection.
#39
https://link.springer.com/article/10.1007/s00384-024-04682-z
Diverticular abscess is a common manifestation of acute complicated diverticulitis. […] Abscess diameter3 cm is not just an arbitrary chosen cut-off value for drainage placement but has a prognostic impact on medical treatment failure in patients with complicated acute diverticulitis. […] The failure rate of initial conservative management ranges between 13.9 and 20%. […] Abscess size is recognized as a predictive outcome factor following initial medical therapy. […] An abscess diameter larger than 3 cm is a predictive risk factor of non-operative treatment failure. […] Both antibiotic therapy and percutaneous drainage are feasible and safe options in the management of larger abscesses with similar perioperative outcomes and postoperative complications. […] In patients undergoing surgery for diverticular abscess, the risk of overall stoma formation increases with a higher BMI.
#40
https://link.springer.com/article/10.1007/s00384-024-04682-z
Diverticular abscess is a common manifestation of acute complicated diverticulitis. […] Abscess diameter3 cm is not just an arbitrary chosen cut-off value for drainage placement but has a prognostic impact on medical treatment failure in patients with complicated acute diverticulitis. […] The failure rate of initial conservative management ranges between 13.9 and 20%. […] Abscess size is recognized as a predictive outcome factor following initial medical therapy. […] An abscess diameter larger than 3 cm is a predictive risk factor of non-operative treatment failure. […] Both antibiotic therapy and percutaneous drainage are feasible and safe options in the management of larger abscesses with similar perioperative outcomes and postoperative complications. […] In patients undergoing surgery for diverticular abscess, the risk of overall stoma formation increases with a higher BMI.
#41 Diverticular disease: update on pathophysiology, classification and management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10935533/
Diverticular haemorrhage is a frequent complication that occurs in 5%15% of patients. […] The risk of complications decreases with further episodes. […] There is an overall 20% risk of recurrence with 8% experiencing a further attack within the first year. Rate of recurrence increases following additional episodes: 18% at 1 year following a second episode and 40% at 3 years after a third episode. […] Elective surgery should be decided on a case-by-case basis, not by number of episodes. […] Most complications related to diverticulitis occur during the primary episode. […] Chronic symptoms associated with DD including SUDD and the reported IBS-like symptoms are difficult to manage and present a significant healthcare burden.
#42 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://pmc.ncbi.nlm.nih.gov/articles/PMC7911244/
The PACO-D score should be considered as a supportive tool to the CT scan of the abdomen, which remains essential not only to confirm the diagnosis of complicated AD but above all to plan the subsequent treatment. […] The PACO-D score, developed in a large sample of patients with AD and then validated in an equally large prospective cohort, may represent a useful prognostic model in the management of patients with AD referred to the ED.
#43 Diverticulitis: Symptoms, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/10352-diverticulitis
Diverticulitis is an uncommon complication. […] Once you’ve had it, you have a 20% chance of getting it again. […] Diverticulitis is uncomplicated 80% of the time. […] Only a small percentage of people will have complicated diverticulitis, and only a small percentage of those will need surgery. […] In most cases, even complicated diverticulitis resolves quickly and completely with treatment. […] Diverticulitis shouldn’t affect your overall life expectancy. Only in the unlikely event of a bowel perforation or a ruptured abscess would you be at risk of life-threatening complications.
#44 Diverticulitis: Symptoms, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/10352-diverticulitis
Diverticulitis is an uncommon complication. […] Once you’ve had it, you have a 20% chance of getting it again. […] Diverticulitis is uncomplicated 80% of the time. […] Only a small percentage of people will have complicated diverticulitis, and only a small percentage of those will need surgery. […] In most cases, even complicated diverticulitis resolves quickly and completely with treatment. […] Diverticulitis shouldn’t affect your overall life expectancy. Only in the unlikely event of a bowel perforation or a ruptured abscess would you be at risk of life-threatening complications.
#45 Diverticulitis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/173388-overview
The prognosis in patients with diverticulitis depends on the severity of the illness, the presence of complications, and the presence of any coexisting medical problems. Younger patients with diverticulitis may have more severe disease, possibly due to a delay in the diagnosis and treatment. Immunosuppressed patients have significantly higher morbidity and mortality due to sigmoid diverticulitis. […] Of the patients who have diverticulosis, 80%-85% remain asymptomatic. Approximately 5% develop diverticulitis; 15%-25% of those with diverticulitis develop complications that lead to surgical intervention. These complications include abscess formation, intestinal rupture, peritonitis, and fistula formation. […] Diverticulitis may be a more severe illness in those who are immunocompromised, who have significant comorbid conditions, and in those taking anti-inflammatory medications. Note the following: After a first occurrence of acute diverticulitis, the 5-year recurrence rate is 20%.
#46 Diverticular disease: update on pathophysiology, classification and management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10935533/
Diverticular haemorrhage is a frequent complication that occurs in 5%15% of patients. […] The risk of complications decreases with further episodes. […] There is an overall 20% risk of recurrence with 8% experiencing a further attack within the first year. Rate of recurrence increases following additional episodes: 18% at 1 year following a second episode and 40% at 3 years after a third episode. […] Elective surgery should be decided on a case-by-case basis, not by number of episodes. […] Most complications related to diverticulitis occur during the primary episode. […] Chronic symptoms associated with DD including SUDD and the reported IBS-like symptoms are difficult to manage and present a significant healthcare burden.
#47 Diverticular disease: update on pathophysiology, classification and management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10935533/
Colonic diverticulosis is prevalent, affecting approximately 70% of the western population by 80 years of age. […] Between 10% and 25% of those with diverticular disease (DD) will experience acute diverticulitis. A further 15% will develop complications including abscess, bleeding and perforation. Such complications are associated with significant morbidity and mortality and constitute a worldwide health burden. […] The cost burden of DD is rising with a reported annual cost of US$5.5 billion in the USA in 2019. […] The most common complication of DD is acute diverticulitis, which is defined as DD with signs and symptoms of diverticular inflammation. […] Complicated diverticulitis most frequently involves a pericolonic abscess (~70%), followed by colonic perforation with purulent or faecal peritonitis (~27%), followed by fistula (~14%).
#48 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://www.mdpi.com/2075-4426/11/2/80
The PACO-D score showed fair discrimination for complicated AD with an area under the receiver operating characteristic curve of 0.674 and 0.648, in the retrospective and prospective cohorts, respectively. […] In the last two decades, particularly in Western countries, the prevalence and hospitalization rate of AD and its complications have progressively increased, placing a considerable burden on national health systems. […] Complications occur in approximately 12% of patients with AD, and mortality after complicated diverticulitis is highest among individuals with perforation or abscesses. […] Thus, it is extremely important to identify patients with AD who are at the highest risk of having a complicated disease and, consequently, a worse outcome. […] The PACO-D score, developed in a large sample of patients with AD and then validated in an equally large prospective cohort, may represent a useful prognostic model in the management of patients with AD referred to the ED.
#49 Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
https://pmc.ncbi.nlm.nih.gov/articles/PMC7911244/
Thus, the aim of this study was to develop and validate an easy-to-apply score, which includes several variables independently associated with complicated AD, in order to identify the patients at highest risk of developing complicated AD among all patients referred to the ED with a diagnosis of AD. […] In the multivariate logistic regression analysis for factors associated with complicated AD, male sex, constipation, Hb levels 11.9 g/dL, CRP 80 mg/mL, obesity, and not being on PPI remained significantly correlated with complicated AD. […] As expected, in-hospital mortality, major complications, surgery, percutaneous drainage, and colostomy placement were significantly more frequent in patients with complicated AD. […] The PACO-D score ranks patients into three risk classes for complicated AD: patients of the derivation cohort in the high-risk group showed an eight-fold greater risk of complicated AD and a six-fold greater risk of cumulative major complications than those in the low-risk group considered as reference.
#50 Diverticulitis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/173388-overview
Patients with diverticulitis who are managed conservatively (ie, do not undergo surgery) have a recurrence rate of 20%-35%. […] In a study of 252 patients, a 47% recurrence rate was reported after 7 years. […] Another study of 337 patients hospitalized for complicated diverticulitis revealed an association of perforation and mortality in those without a prior history of diverticulitis. […] These morbidity and mortality data, as well as the recurrence rates, are based on a retrospective review of relatively short-term data. […] Many studies have demonstrated the significant association between obesity and the risk of developing diverticulitis.