From the Guidelines
To determine the severity of diverticulitis, C-reactive protein (CRP) is the most useful laboratory test, with a cutoff value of 150 mg/l significantly discriminating between acute uncomplicated and complicated diverticulitis 1.
Laboratory Tests for Diverticulitis
Several laboratory tests are essential to determine the severity of diverticulitis, including:
- Complete blood count (CBC) to assess white blood cell count, which typically elevates during infection
- C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to measure inflammation levels, with higher values suggesting more severe disease
- Comprehensive metabolic panel to evaluate kidney and liver function
- Blood cultures to identify bacteria if systemic infection is suspected
- Urinalysis to rule out urinary tract causes of abdominal pain
- Stool studies to exclude other gastrointestinal conditions
Importance of CRP in Diverticulitis
CRP is a crucial marker in determining the severity of diverticulitis, with higher values indicating more severe disease. A study published in 2020 found that CRP values above 150 mg/l were associated with a higher risk of complicated diverticulitis 1. Another study published in 2021 found that CRP levels above 140 mg/l were a predictor of progression to complicated disease among patients with uncomplicated acute diverticulitis 1.
Clinical Presentation and Imaging Studies
In addition to laboratory tests, clinical presentation and imaging studies, particularly CT scans, are essential in determining the severity of diverticulitis. The American College of Physicians recommends using abdominal CT imaging when there is diagnostic uncertainty in a patient with suspected acute left-sided colonic diverticulitis 1.
Treatment Decisions
The severity of diverticulitis guides treatment decisions, with elevated inflammatory markers and leukocytosis correlating with disease severity. Outpatient management with oral antibiotics may be sufficient for uncomplicated diverticulitis, while hospitalization with IV antibiotics and possibly surgical intervention may be necessary for complicated diverticulitis 1.
From the Research
Determining the Severity of Diverticulitis
To determine the severity of diverticulitis, several laboratory tests and imaging studies are utilized. The following are key components in assessing the severity:
- Complete blood count (CBC) to evaluate for signs of infection or inflammation 2, 3
- Basic metabolic panel (BMP) to assess for any electrolyte imbalances or renal dysfunction 2, 3
- Urinalysis to check for any urinary tract involvement or infection 2, 3
- C-reactive protein (CRP) measurement to assess the level of inflammation 2, 3, 4
- Computed tomography (CT) scan with intravenous contrast to confirm the diagnosis, assess the extent and severity of the disease, and exclude any complications 2, 5, 3, 4
Classification of Diverticulitis
Diverticulitis can be classified as uncomplicated or complicated based on the presence of abscesses, perforation, or other severe complications. This classification is crucial in directing management:
- Uncomplicated diverticulitis: characterized by localized diverticular inflammation without any complications 2, 5
- Complicated diverticulitis: characterized by the presence of abscesses, perforation, or other severe complications 2, 5, 4
Predictors of Severe Diverticulitis
Several factors have been identified as predictors of severe diverticulitis, including: