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

Area of Science:

• Gastroenterology
• Clinical Epidemiology

Background:

• Diverticulitis affects a significant patient population, with a notable percentage developing complications.
• Early identification of complicated diverticulitis is essential for appropriate patient management and treatment strategies.

Purpose of the Study:

• To systematically review and identify risk factors predictive of complicated diverticulitis.
• To inform early treatment decisions by understanding predictors of disease severity.

Main Methods:

• Systematic review of Embase, MEDLINE, and Cochrane databases.
• Inclusion of studies defining complicated diverticulitis using Hinchey ≥Ib or Ambrosetti criteria.
• Meta-analysis conducted for outcomes reported in at least four studies, adhering to PRISMA guidelines.

Main Results:

• Twelve studies with 4619 patients were included, generally of reasonable quality.
• Age and sex did not show a significant effect on the risk of complicated diverticulitis.
• Evidence suggests high C-reactive protein, elevated white blood cell count, specific clinical signs (generalized abdominal pain, constipation, vomiting), steroid use, primary episode, and comorbidities are associated with complicated diverticulitis.

Conclusions:

• Several risk factors for complicated diverticulitis were identified, though high-level evidence is limited.
• Individual risk factors have limited predictive value for diverticulitis outcomes.
• A prognostic model combining identified risk factors is proposed to aid physicians in predicting disease course and guiding initial treatment.