Predictors of acute diverticulitis severity: A systematic review

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Medical Diagnostics

Background:

• Diverticulitis presents with variable severity, lacking specific predictive tools for disease progression.
• Existing scoring systems focus on diagnosis and prognosis of severe complications, not initial severity prediction.
• Predicting acute diverticulitis severity is underexplored, necessitating identification of key predictive factors.

Purpose of the Study:

• To systematically review and identify factors that predict severe acute diverticulitis.
• To inform early clinical decision-making and resource allocation for diverticulitis patients.

Main Methods:

• A systematic literature search was conducted across major databases (Medline, PubMed, EMBASE, Cochrane Library).
• Studies evaluating predictors of severe diverticulitis were included.
• Severe diverticulitis was defined by complications (hemorrhage, abscess, perforation, peritonitis, obstruction) or adverse outcomes (prolonged admission, surgery, death).

Main Results:

• Twenty-one articles were analyzed, categorizing predictors into patient characteristics, medications, biochemical markers, and imaging.
• Key predictors of severe diverticulitis include: first episode, high Charlson comorbidity score (≥3), NSAID use, steroid use, elevated C-reactive protein (CRP) on admission, and severe findings on radiological imaging.
• Age and gender were not found to be associated with disease severity.

Conclusions:

• Several factors can predict severe acute diverticulitis, aiding in risk stratification.
• Computed Tomography (CT) remains the gold standard for diagnosing complicated diverticulitis.
• Patients with identified risk factors require early imaging, close observation, and potentially earlier surgical intervention, while those without may be managed as outpatients.