The value of inflammation markers and body temperature in acute diverticulitis

Wall, Bryan Joost Marinus van de; Draaisma, Werner A.; Kaaij, Rosa T. van der; Consten, E.C.J.; Wiezer, Marinus J.; Broeders, I. A. M. J.

doi:10.1111/codi.12072

Cited by 64 publications

(74 citation statements)

References 9 publications

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“…Studies have shown that certain elevated inflammatory markers may have potential use in differentiating between complicated and uncomplicated cases, yet their exact role is yet to be defined. (14)(15)(16)(17)(18)(19)(20)(21) Table 3 demonstrates recent studies that have been conducted and the findings of significance for the biochemical marker tested.…”

Section: Discussionmentioning

confidence: 99%

“…Past studies have also shown WBC to be higher in complicated diverticulitis (15,17,18) Bilirubin on the other hand is a marker that has had very little investigation in relation to acute diverticulitis although being shown to have high sensitivities and specificities for perforation in acute sigmoid diverticulitis. (18) Hyperbilirubinemia has been described in case reports of complicated acute diverticulitis (26,27)and has been linked to extra-hepatic bacterial infection inducing cholestasis and hepatic portal vein gas as a cause.…”

Section: Discussionmentioning

confidence: 99%

“…(11)(12)(13) Many researchers (Makela, Van de Wal, Longstreth) have investigated the efficacy of biochemical inflammatory markers in the diagnosis of acute diverticulitis. (14)(15)(16)Leukocytosis has been demonstrated to be more prevalent in severe cases of diverticulitis, (16) with white cell count (WBC) shown to be significantly higher in complicated vs uncomplicated diverticulitis. (15,17,18) Similarly, C-reactive protein (CRP) has been shown as a useful supporting tool in diagnosing the clinical severity of acute diverticulitis.…”

Section: Introductionmentioning

confidence: 99%

“…(14)(15)(16)Leukocytosis has been demonstrated to be more prevalent in severe cases of diverticulitis, (16) with white cell count (WBC) shown to be significantly higher in complicated vs uncomplicated diverticulitis. (15,17,18) Similarly, C-reactive protein (CRP) has been shown as a useful supporting tool in diagnosing the clinical severity of acute diverticulitis. (14,(18)(19)(20)(21) Among other markers hyperbilirubinemia, although having a low sensitivity, has been shown to have a high specificity and positive predictive value for perforation in acute diverticulitis and may be a focus for future research.…”

Section: Introductionmentioning

confidence: 99%

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The Use of Biochemical Markers in Complicated and Uncomplicated Acute Diverticulitis

Kumarasinghe

Zahid

O’Grady

et al. 2018

International Surgery

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Abstract:Abstract BACKGROUND: Diverticulosis is extremely common in western society. A recent study has shown that outpatient, non-antibiotic management of acute uncomplicated diverticulitis may be a feasible and safe option. However the ability to identify these patients is still difficult. This study explores the ability of white cell count, C-reactive protein and bilirubin in differentiating patients with complicated and uncomplicated diverticulitis as well as progression to surgical intervention. METHODS: This is a retrospective study of patients admitted with acute diverticulitis over a 5-year period (2009)(2010)(2011)(2012)(2013)(2014) at a single institution in Australia. Patients were classified into three groups; uncomplicated diverticulitis, complicated diverticulitis without surgery and complicated diverticulitis with surgery. ANOVA and Bonferroni's post-hoc analyses were used to compare markers across the groups. RESULTS: A total of 541 patients met the inclusion criteria for this study. One-way ANOVA showed a significant difference in white cell count (p<0.0001), C-reactive protein (p<0.0001) and bilirubin (p=0.0006) between all three groups. Post-hoc analyses showed a significant difference in white cell count, C-reactive protein and bilirubin when comparing uncomplicated diverticulitis against complicated diverticulitis without surgery (p<0.05) and complicated diverticulitis with surgery (p<0.05). White cell count also showed a significant difference when comparing complicated diverticulitis without surgery and complicated diverticulitis with surgery (p<0.05). CONCLUSIONS: White cell count, C-reactive protein and bilirubin can distinguish between uncomplicated and complicated diverticulitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Use of Biochemical Markers in Complicated and Uncomplicated Acute Diverticulitis

Kumarasinghe

Zahid

O’Grady

et al. 2018

International Surgery

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“…This modified version includes the substage Ia, which can now be differentiated due to recent technological advances. The degrees of radiological classification, together with clinical data, allow for a better management of this clinical entity (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

The use of the modified Neff classification in the management of acute diverticulitis

Mora¹,

Clotet

Serra‐Aracil³

et al. 2017

Rev Esp Enferm Dig

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Introduction: Acute diverticulitis (AD) is increasingly seen in Emergency services. The application of a reliable classification is vital for its safe and effective management.Objective: To determine whether the combined use of the modified Neff radiological classification (mNeff) and clinical criteria (systemic inflammatory response syndrome [SIRS] and comorbidity) can ensure safe management of AD.Material and methods: Prospective descriptive study in a population of patients diagnosed with AD by computerized tomography (CT). The protocol applied consisted in the application of the mNeff classification and clinical criteria of SIRS and comorbidity to guide the choice of outpatient treatment, admission, drainage or surgery.Results: The study was carried out from February 2010 to February 2016. A total of 590 episodes of AD were considered: 271 women and 319 men, with a median age of 60 years (range: 25-92 years). mNeff grades were as follows: grade 0 (408 patients 70.6%); 376/408 (92%) were considered for home treatment; of these 376 patients, 254 (67.5%) were discharged and controlled by the Home Hospitalization Unit; 33 returned to the Emergency Room for consultation and 22 were re-admitted; the success rate was 91%. Grade Ia (52, 8.9%): 31/52 (59.6%) were considered for outpatient treatment; of these 31 patients, 11 (35.5%) were discharged; eight patients returned to the Emergency Room for consultation and five were re-admitted. Grade Ib (49, 8.5%): five surgery and two drainage. Grade II (30, 5.2%): ten surgery and four drainage. Grade III (5, 0.9%): one surgery and one drainage. Grade IV (34, 5.9%): ten patients showed good evolution with conservative treatment. Of the 34 grade IV patients, 24 (70.6%) underwent surgery, and three (8.8%) received percutaneous drainage.Conclusions: The mNeff classification is a safe, easy-to-apply classification based on CT findings. Together with clinical data and comorbidity data, it allows better management of AD.

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Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis

McDermott

Collins

Heeney

et al. 2014

Journal of British Surgery

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Background: The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis has evolved towards more conservative and minimally invasive strategies. The aim of this review is to highlight recent concepts and advances in management.Methods: A literature review was performed on the electronic databases MEDLINE from PubMed, Embase and the Cochrane Library for publications in English. The keywords 'diverticulitis', 'diverticular' were searched for the past decade (to September 2013).Results: Diverticulitis occurs frequently in the Western world, but only one in five patients develops complications (such as abscess and perforation) during the first acute presentation. The reported perforation rate is 3·5 per 100 000 population. Based on recent data, including the AVOD and DIVER trials, antibiotic therapy for mild episodes may be unnecessary and outpatient management reasonable in most patients. Antibiotics and admission to hospital is required for complicated diverticulitis confirmed on imaging and for patients with sepsis. Diverticular abscesses (about 5 per cent of patients) may require percutaneous drainage if antibiotics alone fail. Laparoscopic management of non-faecal perforated diverticulitis is feasible in selected patients, and peritoneal lavage in combination with antibiotic therapy may avoid colonic resection and a stoma. However, the collective, published worldwide experience is limited to fewer than 800 patients, and results from ongoing randomized trials (LapLAND, SCANDIV, DILALA and LADIES trials) are needed to inform better decision-making. Conclusion:The treatment of diverticulitis continues to evolve with a trend towards a more conservative and minimally invasive management approach. Judicious use of antibiotics in uncomplicated cases, greater application of laparoscopic techniques, and primary resection and anastomosis are of benefit in selected patients.

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The value of inflammation markers and body temperature in acute diverticulitis

Cited by 64 publications

References 9 publications

The Use of Biochemical Markers in Complicated and Uncomplicated Acute Diverticulitis

The Use of Biochemical Markers in Complicated and Uncomplicated Acute Diverticulitis

The use of the modified Neff classification in the management of acute diverticulitis

Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis

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