Prognostic performance of the 'DICA' endoscopic classification and the 'CODA' score in predicting clinical outcomes of diverticular disease: an international, multicentre, prospective cohort study. Issue 7 (26th October 2021)

• Record Type: Journal Article
• Authors: Tursi, Antonio; Brandimarte, Giovanni; Di Mario, Francesco; Elisei, Walter; Picchio, Marcello; Allegretta, Leonardo; Annunziata, Maria Laura; Bafutto, Mauro; Bassotti, Gabrio; Bianco, Maria Antonietta; Colucci, Raffaele; Conigliaro, Rita; Dumitrascu, Dan; Escalante, Ricardo; Ferrini, Luciano; Forti, Giacomo; Franceschi, Marilisa; Graziani, Maria Giovanna; Lammert, Frank; Latella, Giovanni; Maconi, Giovanni; Nardone, Gerardo; Camara de Castro Oliveira, Lucia; Chaves Oliveira, Enio; Papa, Alfredo; Papagrigoriadis, Savvas; Pietrzak, Anna; Pontone, Stefano; Poskus, Tomas; Pranzo, Giuseppe; Reichert, Matthias Christian; Rodinò, Stefano; Regula, Jaroslaw; Scaccianoce, Giuseppe; Scaldaferri, Franco; Vassallo, Roberto; Zampaletta, Costantino; Zullo, Angelo; Piovani, Daniele; Bonovas, Stefanos; Danese, Silvio;
• Other Names: author non-byline.; Astegiano Marco author non-byline.; Baldassarre Gianluca author non-byline.; Baldi Fabio author non-byline.; Borsotti Edoardo author non-byline.; Cazzato Alessia author non-byline.; Chiri Stefania author non-byline.; Ciccone Antonio author non-byline.; Compare Debora author non-byline.; Damiani Alberto author non-byline.; Colibus Patrizia De author non-byline.; Faggiani Roberto author non-byline.; Finocchiaro Fabio author non-byline.; Fiorella Serafina author non-byline.; Foschia Francesca author non-byline.; Furfaro Federica author non-byline.; Gallina Sara author non-byline.; Giorgetti Gian Marco author non-byline.; Grad Simona author non-byline.; Grande Giuseppe author non-byline.; Grandolfo Antonio author non-byline.; Lai Maria Antonia author non-byline.; Lecca Piera Giuseppina author non-byline.; Lisi Daniele author non-byline.; Lopetuso Loris Riccardo author non-byline.; Penna Antonio author non-byline.; Portincasa Piero author non-byline.; Rizzatti Giannenrico author non-byline.; Rizzo Giovanni Luca author non-byline.; Scanni Stefania author non-byline.; Schiffino Luigi author non-byline.; Spaziani Erasmo author non-byline.; Stundiene Ieva author non-byline.; Tesoriere Antonino author non-byline.; Torti Gabriele author non-byline.; Urgesi Riccardo author non-byline.; Usai Paolo author non-byline.;
• Is Part Of: Gut. Volume 71:Issue 7(2022)
• Page Start: 1350
• Page End: 1358
• Publication Date: 2021-10-26
• Subjects: diverticular disease -- endoscopy; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2021-325574
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: To investigate the predictive value of the Diverticular Inflammation and Complication Assessment (DICA) classification and to develop and validate a combined endoscopic-clinical score predicting clinical outcomes of diverticulosis, named Combined Overview on Diverticular Assessment (CODA). Design: A multicentre, prospective, international cohort study. Setting: 43 gastroenterology and endoscopy centres located in Europe and South America. Participants: 2215 patients (2198 completing the study) at the first diagnosis of diverticulosis/diverticular disease were enrolled. Patients were scored according to DICA classifications. Interventions: A 3-year follow-up was performed. Main outcome measures: To predict the acute diverticulitis and the surgery according to DICA classification. Survival methods for censored observation were used to develop and validate a novel combined endoscopic-clinical score for predicting diverticulitis and surgery (CODA score). Results: The 3-year cumulative probability of diverticulitis and surgery was of 3.3% (95% CI 2.5% to 4.5%) in DICA 1, 11.6% (95% CI 9.2% to 14.5%) in DICA 2 and 22.0% (95% CI 17.2% to 28.0%) in DICA 3 (p<0.001), and 0.15% (95% CI 0.04% to 0.59%) in DICA 1, 3.0% (95% CI 1.9% to 4.7%) in DICA 2 and 11.0% (95% CI 7.5% to 16.0%) in DICA 3 (p<0.001), respectively. The 3-year cumulative probability of diverticulitis and surgery was ≤4%, and ≤0.7% in CODA A; <10% and <2.5% in CODA B; >10% and >2.5% in CODA C, respectively. The CODA score showed optimal discrimination capacity in predicting the risk of surgery in the development (c-statistic: 0.829; 95% CI 0.811 to 0.846) and validation cohort (c-statistic: 0.943; 95% CI 0.905 to 0.981). Conclusions: DICA classification has a significant role in predicting the risk of diverticulitis and surgery in patients with diverticulosis, which is significantly enhanced by the CODA score. Trial registration number: NCT02758860 .