Early risk stratification of acute diverticulitis using procalcitonin, CRP, and CT imaging: A retrospective analysis

Computed tomography (CT) is the gold standard diagnostic tool for acute diverticulitis (5).Clinical and treatment decisions mainly depend on the CT results.However, clinical symptoms such as abdominal pain, fever, and leukocytosis lack specificity, while CT findings may not always correlate with disease severity in the early stages.Inflammatory biomarkers, particularly C-reactive protein (CRP), have emerged as potential predictors in risk stratification.Recent studies emphasized the importance of CRP in the severity of diverticulitis (6).However, CRP, a nonspecific acute-phase reactant, rises proportionally to tissue inflammation, whereas procalcitonin, a more specific marker for bacterial infections, may better indicate ABSTRACT Objective: Distinguishing mild (Hinchey 1a/1b/2) from severe (Hinchey 3/4) diverticulitis is critical for appropriate management.This study evaluated the predictive value of inflammatory biomarkers and imaging features for early risk stratification. Material and Methods:We conducted a retrospective analysis of patients with acute diverticulitis between 2017 and 2024 at the hospital's general surgery department.Receiver operating characteristic analysis was used to determine optimal cut-off values for C-reactive protein (CRP) and procalcitonin, while computed tomography (CT) findings were assessed for their discriminative capacity.Results: A total of 72 patients were included in the study.There were 59 patients in the mild diverticulitis group and 13 patients in the severe diverticulitis group.Patient demographics were similar between the groups.Procalcitonin demonstrated superior predictive performance [area under the curve (AUC) 0.795] compared to CRP (AUC 0.755).The cut-off values for procalcitonin and CRP were 0.095 and 104.5, respectively.Specific CT patterns showed high specificity for severe disease.The combination of biomarkers and imaging criteria significantly improved diagnostic accuracy, with pelvic abscess localization emerging as a key indicator of severity.Conclusion: A biomarker-guided approach incorporating procalcitonin and targeted CT evaluation enables reliable early identification of severe diverticulitis.This strategy may enhance clinical decision-making regarding antibiotic selection and surgical consultation while reducing unnecessary interventions in mild cases.