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Assessment of risk for recurrent diverticulitis: a proposal of risk score for complicated recurrence.

Sallinen V, Mali J, Leppäniemi A, Mentula P - Medicine (Baltimore) (2015)

Bottom Line: 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.The risk for uncomplicated recurrence increases along with increasing number of previous diverticulitis.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Abdominal Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.

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.

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Related in: MedlinePlus

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).
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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).

Mentions: The risk score performed well in predicting complicated recurrence (AUC 0.80, SE 0.06, 95% confidence interval 0.69–0.92, P < 0.0001), but not in predicting uncomplicated recurrence (AUC 0.48, SE 0.03, 95% confidence interval 0.42–0.53, P = 0.42) (Figure 1). Cutoff for low risk versus high risk was determined by the point in ROC curve, in which positive and negative predictive values were highest. This point was at risk score of ≥3 points. Accordingly, patients with risk score 0 to 2 points were classified as low risk, and patients with more than 2 points (3–6 points) were classified as high risk.


Assessment of risk for recurrent diverticulitis: a proposal of risk score for complicated recurrence.

Sallinen V, Mali J, Leppäniemi A, Mentula P - Medicine (Baltimore) (2015)

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).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554145&req=5

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).
Mentions: The risk score performed well in predicting complicated recurrence (AUC 0.80, SE 0.06, 95% confidence interval 0.69–0.92, P < 0.0001), but not in predicting uncomplicated recurrence (AUC 0.48, SE 0.03, 95% confidence interval 0.42–0.53, P = 0.42) (Figure 1). Cutoff for low risk versus high risk was determined by the point in ROC curve, in which positive and negative predictive values were highest. This point was at risk score of ≥3 points. Accordingly, patients with risk score 0 to 2 points were classified as low risk, and patients with more than 2 points (3–6 points) were classified as high risk.

Bottom Line: 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.The risk for uncomplicated recurrence increases along with increasing number of previous diverticulitis.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Abdominal Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.

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.

Show MeSH
Related in: MedlinePlus