Ann Surg Treat Res.  2021 Jun;100(6):347-355. 10.4174/astr.2021.100.6.347.

Predictive factors for conservative treatment failure of right colonic diverticulitis

• Park YY
• Nam S
• Han JH
• Lee J
• Cheong C

• KMID: 2516228
• DOI: http://doi.org/10.4174/astr.2021.100.6.347

Abstract

Purpose
Conservative treatment is the first-line therapy for acute colonic diverticulitis without severe complications, but treatment failure may increase hospitalization duration, medical costs, and morbidities. Usage of the modified Hinchey classification is insufficient to predict the outcome of conservative management. We aimed to investigate the clinical efficacy of the modified Hinchey classification and to evaluate predictive factors such as inflammatory markers for the failure of conservative management.
Methods
Patients diagnosed with right colonic diverticulitis undergoing conservative treatment at 3 hospitals between 2017 and 2019 were included. Patients were categorized into conservative treatment success (n = 494) or failure (n = 46) groups. Clinical characteristics and blood inflammatory markers were assessed.
Results
The conservative treatment failure group presented with more elderly patients (>50 years, P = 0.002), more recurrent episodes (P < 0.001), a higher lymphocyte count (P = 0.021), higher C-reactive protein (CRP) levels (P = 0.044), and higher modified Glasgow prognostic scores (P = 0.021). Multivariate analysis revealed that age of >50 years (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.27–5.08; P = 0.008), recurrent episodes (OR, 4.78; 95% CI, 2.38–9.61; P < 0.001), and higher CRP levels (OR, 1.08; 95% CI, 1.03–1.12; P = 0.001) were predictive factors for conservative treatment failure, but not the modified Hinchey grade (P = 0.159).
Conclusion
Age of >50 years, recurrent episodes, and CRP levels are potential predictors for conservative management failure of patients with right-sided colonic diverticulitis. Further studies are warranted to identify candidates requiring early surgical intervention.

Keyword

Colonic diverticulitis; Conservative treatment; C-reactive protein; Inflammatory response; Recurrence

Figure

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  Fig. 1 Study population and management at admission.

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  Fig. 2 Receiver operating characteristics (ROC) curves for cutoff value of CRP to determine the failure of conservative management for right colonic diverticulitis. On the x axis, false-positive/1-specificity, and on the y axis, true positive/sensitivity are expressed. AUC, area under the ROC curve.

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