Comorbidity is a major determinant of severity in acute diverticulitis

Acute colonic diverticulitis may be simple or very complicated. Not much is understood about what factors determine severity. Answering this question may have therapeutic implications.

A retrospective review was performed consisting of teaching hospital admissions for simple or complicated acute diverticulitis. The intent was to identify characteristics of and differences between the 2 groups. The Charlson index was used to assess states of preexisting health (comorbidity).

In multivariate analysis, the presence of a major degree of comorbidity (Charlson score 3 or greater) was strongly associated with complicated disease (P = 0.02) as was the use of nonsteroidal anti-inflammatory drugs (P = .01). Deaths were not seen below age 50, and high Charlson score also strongly predicted mortality (P < .0001).

There are significant differences between patients presenting with simple and complicated diverticulitis, and the amount of associated comorbidity (as measured by Charlson score) appears to be a major one. Because of the high mortality seen in patients with Charlson scores 3 or greater and complicated diverticulitis, we believe that an early surgical approach should be considered for them, particularly if they are 50 or older.