Development and validation of predictive assessment of complicated diverticulitis score

Marcello Covino, Valerio Papa, Francesco Franceschi, Antonio Gasbarrini, Alfredo Papa, Benedetta Simeoni, Loris Riccardo Lopetuso, Lorenzo Maria Vetrone, Gian Ludovico Rapaccini, Antonio Tursi

Research output: Contribution to journalArticle


The prevalence of acute diverticulitis (AD) has progressively increased in recent decades, with correspondingly greater morbidity and mortality. The aim of the study is to develop a predictive score to identify patients with the highest risk of complicated AD. The clinical records of 1089 patients referred to the emergency department (ED) over a five-year period were reviewed. In multivariate analysis, male sex (p < 0.001), constipation (p = 0.002), hemoglobin < 11.9 g/dL (p < 0.001), C reactive protein > 80 mg/L (p < 0.001), severe obesity (p = 0.049), and no proton pump inhibitor treatment (p = 0.003) were independently associated with complicated AD. The predictive assessment of complicated (PACO)-diverticulitis (D) score, including these six variables, was applied to the retrospective cohort and then validated prospectively in a cohort including 282 patients. It categorized patients into three risk classes for complicated AD. The PACO-D score showed fair discrimination for complicated AD with an area under the receiver operating characteristic curve of 0.674 and 0.648, in the retrospective and prospective cohorts, respectively. The PACO-D score could be a practical clinical tool to identify patients at highest risk for complicated AD referred to the ED so that appropriate diagnostic and therapeutic resources could be appropriately allocated. Further external validation is needed to confirm these results.
Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalJournal of Personalized Medicine
Publication statusPublished - 2021


  • Abscess
  • Acute diverticulitis
  • Complicated diverticulitis
  • Diverticular hemorrhage
  • Perforation
  • Prognostic score
  • Surgery


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