Predictive Value of Serologic Markers of Degree of Histologic Damage in Acute Uncomplicated Colonic Diverticulitis

Background: Acute uncomplicated diverticulitis (AUD) may show histologic and serologic signs of inflammation. Goals: To assess whether serologic markers of inflammation may be predictive of abnormal histology in AUD. Study: Twenty-one consecutive patients affected by AUD were studied (15 Males, 6 Females, mean age 66.19 y, range 43 to 85 y). Diagnosis of AUD was based on specific endoscopic and CT scan patterns. Several serologic markers were assessed [White blood cells (WBC), Erytro-sedimentation Rate, C-reactive protein (CRP), fibrinogen, alpha 1-acid glycoprotein]. Neutrophilic and lymphocytic inflammatory infiltrate was also scored. Results: WBC was increased in 4/21 pts (19.4%), Erytrosedimentation Rate in 12/21 pts (57.14%), CRP in 13/21 pts (61.9%), fibrinogen in 5/21 pts (23.8%), and a1-acid glycoprotein in 6/21 pts (28.57%). All serologic markers were related with the degree of histologic damage. In patients scoring 3 in neutrophilic infiltrate (severe active inflammation), all markers showed a statistical significant relation (ranging from P - 0.004 for WBC to P = 0.00001 for fibrinogen). CRP was the most sensitive marker of mild-moderate histologic damage, as it was increased in 4/10 (40%) patients scoring 0 or 1 in neutrophilic infiltrate (absence of mild active inflammation) (P = 0.005). Conclusions: Serologic markers showed a strict relation with the degree of histologic damage in AUD. Moreover, CRP is the most sensitive marker of mild-moderate histologic damage.