title: Predictors of acute diverticulitis severity: A systematic review.
abstract: BACKGROUND
  Diverticulitis is a common condition with a broad spectrum of disease severity. A scoring system has been proposed for diagnosing diverticulitis, and a number of scoring systems exist for predicting prognosis associated with severe complications of diverticulitis such as peritonitis. However, predicting disease severity has not received as much attention. Therefore, the aim of this review was to identify the factors that are predictive of severe acute diverticulitis.
  
  
  METHODS
  A systematic literature search was performed using Medline, PubMed, EMBASE, and the Cochrane Library to identify papers that evaluated factors predictive of severe diverticulitis. Severe diverticulitis was defined as complicated diverticulitis (associated with haemorrhage, abscess, phlegmon, perforation, purulent/faecal peritonitis, stricture, fistula, or small-bowel obstruction) or diverticulitis that resulted in prolonged hospital admission, surgical intervention or death.
  
  
  RESULTS
  Twenty one articles were included. Studies were categorised into those that identified patient characteristics (n = 12), medications (n = 5), biochemical markers (n = 8) or imaging (n = 3) as predictors. Predictors for severe diverticulitis included first episode of diverticulitis, co-morbidities (Charlson score ≥ 3), non-steroidal anti-inflammatory drug use, steroid use, a high CRP on admission and severe disease on radiological imaging. Age and gender were not associated with disease severity.
  
  
  CONCLUSIONS
  A number of predictors exist for identifying severe diverticulitis, and CT remains the gold standard for diagnosing complicated disease. Patients who present with identified risk factors for severe disease warrant early imaging, closer in-patient observation and a lower threshold for early surgical intervention. Patients without these factors may be suitable for outpatient-based treatment.
authors.affiliation: Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: James P L
authors.initials: JP
authors.lastname: Tan
authors.affiliation: Department of Surgery, Lower Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand. Electronic address: zanchibara@gmail.co.nz.
authors.forename: Ahmed W H
authors.initials: AW
authors.lastname: Barazanchi
authors.affiliation: Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Primal P
authors.initials: PP
authors.lastname: Singh
authors.affiliation: Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
authors.affiliation: Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Maccormick
mesh_terms: D000208:Acute Disease; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D002097:C-Reactive Protein / Q000032:analysis; D015897:Comorbidity; D004238:Diverticulitis / Q000150:complications* / Q000000981:diagnostic imaging; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D002097:C-Reactive Protein
keywords: Acute; Diverticulitis; Predictors; Score; Severity