AIM: To determine the diagnostic value of serological infection markers and body temperature in discriminating complicated from uncomplicated diverticulitis. METHODS: Patients in whom diverticulitis was pathologically or radiologically proven at presentation were included. Patients were classified as either complicated (Hinchey Ib, II, III and IV) or uncomplicated (Hinchey Ia) diverticulitis. The discriminative value of C-reactive protein (CRP), white blood cell (WBC) count and body temperature at presentation was tested. RESULTS: A total of 426 patients were included in this study of which 364 (85%) presented with uncomplicated and 62 (15%) with complicated diverticulitis. Only CRP was of sufficient diagnostic value (area under the curve 0.715). The median CRP in patients with complicated diverticulitis was significantly higher than in patients with uncomplicated disease (224 mg/l, range 99-284 vs 87 mg/l, range 48-151). Patients with a CRP of 25 mg/l had a 15% chance of having complicated diverticulitis. This increased from 23% at a CRP value of 100 mg/l to 47% for 250 mg/l or higher. The optimal threshold was reached at 175 mg/l with a positive predictive value of 36%, negative predictive value of 92%, sensitivity of 61% and a specificity of 82%. CONCLUSION: WBC count and body temperature are of no value in discriminating complicated from uncomplicated diverticulitis. Only CRP can be used as an indicator for the presence of complications, but a low CRP does not mean that complicated disease can safely be excluded. Therefore, radiological examination remains central in the diagnostic work-up of patients presenting with diverticulitis.
AIM: To determine the diagnostic value of serological infection markers and body temperature in discriminating complicated from uncomplicated diverticulitis. METHODS:Patients in whom diverticulitis was pathologically or radiologically proven at presentation were included. Patients were classified as either complicated (Hinchey Ib, II, III and IV) or uncomplicated (Hinchey Ia) diverticulitis. The discriminative value of C-reactive protein (CRP), white blood cell (WBC) count and body temperature at presentation was tested. RESULTS: A total of 426 patients were included in this study of which 364 (85%) presented with uncomplicated and 62 (15%) with complicated diverticulitis. Only CRP was of sufficient diagnostic value (area under the curve 0.715). The median CRP in patients with complicated diverticulitis was significantly higher than in patients with uncomplicated disease (224 mg/l, range 99-284 vs 87 mg/l, range 48-151). Patients with a CRP of 25 mg/l had a 15% chance of having complicated diverticulitis. This increased from 23% at a CRP value of 100 mg/l to 47% for 250 mg/l or higher. The optimal threshold was reached at 175 mg/l with a positive predictive value of 36%, negative predictive value of 92%, sensitivity of 61% and a specificity of 82%. CONCLUSION: WBC count and body temperature are of no value in discriminating complicated from uncomplicated diverticulitis. Only CRP can be used as an indicator for the presence of complications, but a low CRP does not mean that complicated disease can safely be excluded. Therefore, radiological examination remains central in the diagnostic work-up of patients presenting with diverticulitis.
Authors: Massimo Sartelli; Fausto Catena; Luca Ansaloni; Federico Coccolini; Ewen A Griffiths; Fikri M Abu-Zidan; Salomone Di Saverio; Jan Ulrych; Yoram Kluger; Ofir Ben-Ishay; Frederick A Moore; Rao R Ivatury; Raul Coimbra; Andrew B Peitzman; Ari Leppaniemi; Gustavo P Fraga; Ronald V Maier; Osvaldo Chiara; Jeffry Kashuk; Boris Sakakushev; Dieter G Weber; Rifat Latifi; Walter Biffl; Miklosh Bala; Aleksandar Karamarkovic; Kenji Inaba; Carlos A Ordonez; Andreas Hecker; Goran Augustin; Zaza Demetrashvili; Renato Bessa Melo; Sanjay Marwah; Sanoop K Zachariah; Vishal G Shelat; Michael McFarlane; Miran Rems; Carlos Augusto Gomes; Mario Paulo Faro; Gerson Alves Pereira Júnior; Ionut Negoi; Yunfeng Cui; Norio Sato; Andras Vereczkei; Giovanni Bellanova; Arianna Birindelli; Isidoro Di Carlo; Kenneth Y Kok; Mahir Gachabayov; Georgios Gkiokas; Konstantinos Bouliaris; Elif Çolak; Arda Isik; Daniel Rios-Cruz; Rodolfo Soto; Ernest E Moore Journal: World J Emerg Surg Date: 2016-07-29 Impact factor: 5.469
Authors: H E Bolkenstein; B J M van de Wall; E C J Consten; I A M J Broeders; W A Draaisma Journal: Int J Colorectal Dis Date: 2017-08-10 Impact factor: 2.571
Authors: Massimo Sartelli; Dieter G Weber; Yoram Kluger; Luca Ansaloni; Federico Coccolini; Fikri Abu-Zidan; Goran Augustin; Offir Ben-Ishay; Walter L Biffl; Konstantinos Bouliaris; Rodolfo Catena; Marco Ceresoli; Osvaldo Chiara; Massimo Chiarugi; Raul Coimbra; Francesco Cortese; Yunfeng Cui; Dimitris Damaskos; Gian Luigi De' Angelis; Samir Delibegovic; Zaza Demetrashvili; Belinda De Simone; Francesco Di Marzo; Salomone Di Saverio; Therese M Duane; Mario Paulo Faro; Gustavo P Fraga; George Gkiokas; Carlos Augusto Gomes; Timothy C Hardcastle; Andreas Hecker; Aleksandar Karamarkovic; Jeffry Kashuk; Vladimir Khokha; Andrew W Kirkpatrick; Kenneth Y Y Kok; Kenji Inaba; Arda Isik; Francesco M Labricciosa; Rifat Latifi; Ari Leppäniemi; Andrey Litvin; John E Mazuski; Ronald V Maier; Sanjay Marwah; Michael McFarlane; Ernest E Moore; Frederick A Moore; Ionut Negoi; Leonardo Pagani; Kemal Rasa; Ines Rubio-Perez; Boris Sakakushev; Norio Sato; Gabriele Sganga; Walter Siquini; Antonio Tarasconi; Matti Tolonen; Jan Ulrych; Sannop K Zachariah; Fausto Catena Journal: World J Emerg Surg Date: 2020-05-07 Impact factor: 5.469