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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

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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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.

Mentions: Low-risk versus high-risk groups showed statistically significant cumulative complicated recurrence-free time in Kaplan–Meier survival analysis (Figure 2B). However, no difference was noted in low-risk versus high-risk groups in regard to uncomplicated recurrence (Figure 2A). Five-year complicated, but not uncomplicated, recurrence-free rate was higher in low-risk group (Table 5).


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)

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

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

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.
Mentions: Low-risk versus high-risk groups showed statistically significant cumulative complicated recurrence-free time in Kaplan–Meier survival analysis (Figure 2B). However, no difference was noted in low-risk versus high-risk groups in regard to uncomplicated recurrence (Figure 2A). Five-year complicated, but not uncomplicated, recurrence-free rate was higher in low-risk group (Table 5).

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