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Observational Study
. 2015 Feb;94(8):e557.
doi: 10.1097/MD.0000000000000557.

Assessment of Risk for Recurrent Diverticulitis: A Proposal of Risk Score for Complicated Recurrence

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Free PMC article
Observational Study

Assessment of Risk for Recurrent Diverticulitis: A Proposal of Risk Score for Complicated Recurrence

Ville Sallinen et al. Medicine (Baltimore). .
Free PMC article

Abstract

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.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
ROC curves showing the predictive ability of the risk score. Notice that the risk score is poor predictor of uncomplicated recurrence (AUC 0.48, SE 0.03, 95% confidence interval 0.42–0.53, P = 0.42), but shows ability to predict complicated recurrence (AUC 0.80, SE 0.06, 95% confidence interval 0.69–0.92, P < 0.0001).
FIGURE 2
FIGURE 2
Kaplan–Meier survival curves. (A) Cumulative uncomplicated recurrence-free time of low-risk (0–2 points) versus high-risk (>2 points) patients. Sensoring for loss of follow-up, death, or sigmoid resection. (B) Cumulative complicated recurrence-free time of low-risk versus high-risk patients. Sensoring for loss of follow-up, death, or sigmoid resection. (C) Cumulative uncomplicated recurrence-free time of patients with or without history of diverticulitis. Sensoring for loss of follow-up, complicated recurrence, death, or sigmoid resection. (D) Cumulative complicated recurrence-free time of patients with or without history of diverticulitis. Sensoring for loss of follow-up, death, or sigmoid resection. pts = patients.

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