title: Comorbidity is a major determinant of severity in acute diverticulitis.
abstract: BACKGROUND
  Acute colonic diverticulitis may be simple or very complicated. Not much is understood about what factors determine severity. Answering this question may have therapeutic implications.
  
  
  METHODS
  A retrospective review was performed consisting of teaching hospital admissions for simple or complicated acute diverticulitis. The intent was to identify characteristics of and differences between the 2 groups. The Charlson index was used to assess states of preexisting health (comorbidity).
  
  
  RESULTS
  In multivariate analysis, the presence of a major degree of comorbidity (Charlson score 3 or greater) was strongly associated with complicated disease (P = 0.02) as was the use of nonsteroidal anti-inflammatory drugs (P = .01). Deaths were not seen below age 50, and high Charlson score also strongly predicted mortality (P < .0001).
  
  
  CONCLUSIONS
  There are significant differences between patients presenting with simple and complicated diverticulitis, and the amount of associated comorbidity (as measured by Charlson score) appears to be a major one. Because of the high mortality seen in patients with Charlson scores 3 or greater and complicated diverticulitis, we believe that an early surgical approach should be considered for them, particularly if they are 50 or older.
authors.affiliation: Department of Surgery, University of Ottawa, Room K-11, Ottawa Hospital/General Site, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6. jlorimer@ottawahospital.on.ca
authors.forename: John W
authors.initials: JW
authors.lastname: Lorimer
authors.forename: Gaby
authors.initials: G
authors.lastname: Doumit
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004239:Diverticulitis, Colonic / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology*; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate