title: The role of C-reactive protein in prediction of the severity of acute diverticulitis in an emergency unit.
abstract: OBJECTIVE
  Computed tomography (CT) is the most appropriate initial imaging modality for the assessment of acute diverticulitis. The aim here was to determine the usefulness of C-reactive protein (CRP) in predicting the severity of the diverticulitis process and the need for a CT examination.
  
  
  METHODS
  The CRP values of 350 patients who presented first time with symptoms of acute diverticulitis and underwent CT imaging on admission to Oulu University Hospital were compared with the CT findings and clinical parameters by means of both univariate and multivariate analyses.
  
  
  RESULTS
  The receiver operating characteristic curve showed that a CRP cut-off value of 149.5 mg/l significantly discriminated acute uncomplicated diverticulitis from complicated diverticulitis (specificity 65%, sensitivity 85%, area under the curve 0.811, p = 0.0001). In multivariate analysis, a CRP value over 150 mg/l and old age were independent risk factors for acute complicated diverticulitis. The mean CRP value was significantly higher in the patients who died, 207 (84 SD), than in those who survived, 139 (SD 83). In addition, a CRP value over 150 mg/l and free abdominal fluid in CT were independent variables predicting postoperative mortality.
  
  
  CONCLUSIONS
  CRP is useful for the predicting the severity of acute diverticulitis on admission. Patients with a CRP value higher than 150 mg/l have an in increased risk of complicated diverticulitis and a CT examination should always be carried out.
authors: Department of Surgery, Oulu University Hospital, Division of Gastroenterology , Kajaanintie 50, 90220 Oulu , Finland.
authors: Jyrki T
authors: JT
authors: Mäkelä
authors: Kai
authors: K
authors: Klintrup
authors: Heikki
authors: H
authors: Takala
authors: Tero
authors: T
authors: Rautio
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D004238:Diverticulitis / Q000175:diagnosis*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; complicated diverticulitis; computed tomography; risk analysis; uncomplicated diverticulitis