Index C-reactive protein predicts increased severity in acute sigmoid diverticulitis

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Emergency Medicine

Background:

• Acute diverticulitis (AD) management depends on radiological severity (Hinchey classification).
• Unperforated AD (Hinchey Ia) and small abscesses (Hinchey Ib) are managed conservatively.
• Severe AD (Hinchey >Ib) with large abscesses or peritonitis often necessitates intervention.

Purpose of the Study:

• To assess C-reactive protein (CRP) as a predictor of severe acute diverticulitis (Hinchey >Ib).
• To differentiate between non-invasively treatable AD (Hinchey Ia/Ib) and complicated AD (Hinchey >Ib) using CRP levels.

Main Methods:

• Prospective data collection from consecutive acute diverticulitis patients.
• Computed tomography (CT) imaging for radiological grading.
• Analysis of initial emergency unit parameters, including CRP, for outcome association.

Main Results:

• Ninety-nine patients analyzed; 11 had severe AD (Hinchey >Ib).
• Median index CRP was significantly higher in severe AD (236 mg/L) versus mild AD (80 mg/L; P<0.001).
• Index CRP >173 mg/L independently predicted severe AD (Hinchey >Ib) with 90.9% sensitivity and specificity (P<0.001).

Conclusions:

• Initial C-reactive protein levels >173 mg/L predict major acute complications in AD.
• Patients with elevated CRP levels often require urgent percutaneous drainage or surgical intervention.