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2015 ; 94
(8
): e557
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Assessment of risk for recurrent diverticulitis: a proposal of risk score for
complicated recurrence
#MMPMID25715253
Sallinen V
; Mali J
; Leppäniemi A
; Mentula P
Medicine (Baltimore)
2015[Feb]; 94
(8
): e557
PMID25715253
show ga
Recurrence of acute diverticulitis is common, and--especially complicated
recurrence--causes significant morbidity. To prevent recurrence, selected
patients have been offered prophylactic sigmoid resection. However, as there is
no tool to predict whose diverticulitis will recur and, in particular, who will
have complicated recurrence, the indications for sigmoid resections have been
variable. The objective of this study was to identify risk factors predicting
recurrence of acute diverticulitis. This is a retrospective cohort study of
patients presenting with computed tomography-confirmed acute diverticulitis and
treated nonresectionally during 2006 to 2010. Risk factors for recurrence were
identified using uni- and multivariate Cox regression. A total of 512 patients
were included. History of diverticulitis was an independent risk factor
predicting uncomplicated recurrence of diverticulitis (1-2 earlier diverticulitis
HR 1.6, 3 or more--HR 3.2). History of diverticulitis (HR 3.3), abscess (HR 6.2),
and corticosteroid medication (HR 16.1) were independent risk factors for
complicated recurrence. Based on regression coefficients, risk scoring was
created: 1 point for history of diverticulitis, 2 points for abscess, and 3
points for corticosteroid medication. The risk score was unable to predict
uncomplicated recurrence (AUC 0.48), but was able to predict complicated
recurrence (AUC 0.80). Patients were further divided into low-risk (0-2 points)
and high-risk (>2 points) groups. Low-risk and high-risk groups had 3% and 43%
5-year complicated recurrence rates, respectively. Risk for complicated
recurrence of acute diverticulitis can be assessed using risk scoring. The risk
for uncomplicated recurrence increases along with increasing number of previous
diverticulitis.
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