Our database included 189 patients who were diagnosed with diverticular disease. However, 55 patients were excluded due to a diagnosis of the first episode outside the hospital, incomplete medical records or loss of follow up (Fig 1 Study flowchart). Accordingly, 134 patients were included in the study; 76 (56.7%) males and 58 (43.3%) females. The median age was 59.5 (Min. – Max.) (25 – 89), Mean ± SD.58.2 ± 13.5. 115 (85.8%) patients presented with diverticulitis and 19 (14.2%) with diverticular bleeding. Group I (young) included 29 patients while Group II (old) included 105 patients.
Comparison of the two groups (Table 1) revealed a gender predilection with male predominance in the young age group with 23 (79.3%) males and 6 (20.7%) females affected. However, in the old group, there was no clear gender preponderance with 53 (50.5%) males and 52 (49.5%) females.
The difference was statistically significant p = 0.006. There was no significant difference regarding nature of presentation whether diverticulitis or diverticular bleeding p= 0.365.
Regarding the extent of colon involvement, the younger age group tended to show more right-side involvement, while the older age group showed more pancolonic distribution however, the difference came under statistical significance. Looking at the comorbidities in both groups there was a significantly higher prevalence of DM, HTN and dyslipidemia in the older age group. P= < 0.001 for all the three. Review of laboratory data at presentation showed lower haemoglobin and vitamin D levels in the older age group, p = < 0.001 and 0.001 respectively with no significant difference of the inflammatory markers including WBC and CRP, p= 0.750 and 0.955. Among the risk factors studied only steroids intake was higher in the old age group, p= 0.004.
Comparison of the clinical course and severity was done (Table 2). Within the 115-patient presented with diverticulitis, there were 27 belonging to group I and 88 from the old age group. Comparison of severity according to Salinnen stage revealed no significant difference between both groups. Likewise, comparison of the management of both groups relevant to management setting (outpatient or inpatient), antibiotics prescription, guided drainage, laparoscopic lavage and the need for surgery, all showed no significant difference, p = 0.447, 0.640, 1.000, 0.296 and 0.523.
Analysis of the outcome parameters revealed a bit longer hospital stay in the older age group relative to the young group with a median (Min. – Max.) of 5 (1 – 33) and 5 (2 – 10) and mean ± SD of 7.1 ± 7 and 4.5 ± 2.6 respectively, however, the difference was insignificant p= 0.442. Recurrence was significantly higher in the young group 41.4% versus 22.9% in the older group, p= 0.046.
Table (1): Comparison between the two studied groups according to different parameters
|
Group I - Young (<50) (n = 29)
|
Group II - Old (≥50) (n = 105)
|
|
|
Gender
|
|
|
|
|
Male
|
23 (79.3%)
|
53 (50.5%)
|
χ2=7.696*
|
0.006*
|
Female
|
6 (20.7%)
|
52 (49.5%)
|
Follow up (months)
|
|
|
|
|
Median (Min. – Max.)
|
18.0 (12 – 27)
|
18.0 (11 – 32)
|
U= 1509.5
|
0.944
|
Mean ± SD.
|
18.4 ± 4.5
|
18.6 ± 5.2
|
Fever
|
7 (24.1%)
|
28 (26.7%)
|
χ2=0.075
|
0.784
|
Presentation
|
|
|
|
|
Diverticulitis
|
27(93.1%)
|
88(83.8%)
|
χ2=1.613
|
0.365
|
Bleeding
|
2(6.9%)
|
17(16.2%)
|
Extent
|
|
|
|
|
Left
|
20 (69%)
|
70 (66.7%)
|
χ2=0.054
|
0.815
|
Right
|
7 (24.1%)
|
11 (10.5%)
|
χ2=3.647
|
0.069
|
Pancolic
|
2 (6.9%)
|
24 (22.9%)
|
χ2=3.702
|
0.054
|
Tobacco
|
7 (24.1%)
|
32 (30.5%)
|
χ2=0.442
|
0.506
|
Alcohol
|
7 (24.1%)
|
11 (10.5%)
|
χ2=3.647
|
0.069
|
BMI
|
|
|
|
|
Median (Min. – Max.)
|
30.7(19.2 – 51)
|
30.6(20.3 – 51.1)
|
t= 0.607
|
0.545
|
Mean ± SD.
|
30.5 ± 6.4
|
31.3 ± 6.2
|
DM
|
4 (13.8%)
|
64 (61%)
|
χ2=20.220*
|
>0.001*
|
HTN
|
7 (24.1%)
|
69 (65.7%)
|
χ2=16.001*
|
>0.001*
|
CKD
|
1 (3.4%)
|
6 (5.7%)
|
χ2=0.236
|
1.000
|
Hypothyroidism
|
1 (3.4%)
|
6 (5.7%)
|
χ2=0.236
|
1.000
|
Dyslipidemia
|
3 (10.3%)
|
59 (56.2%)
|
χ2=19.212*
|
>0.001*
|
IBD
|
0 (0%)
|
0 (0%)
|
-
|
-
|
HGB
|
|
|
|
|
Median (Min. – Max.)
|
14.9 (7.9 – 17)
|
13.0 (5.5 – 16)
|
t= 3.899*
|
>0.001*
|
Mean ± SD.
|
14.3 ± 2
|
12.6 ± 2
|
WBCs
|
|
|
|
|
Median (Min. – Max.)
|
9.9 (4.6 – 18)
|
10.0 (3.3 – 41.4)
|
U= 1463.50
|
0.750
|
Mean ± SD.
|
10.7 ± 3.5
|
11.4 ± 6.6
|
CRP
|
|
|
|
|
Median (Min. – Max.)
|
21.0 (0.6 – 178)
|
15.0 (0.8 – 272.5)
|
U= 1512.0
|
0.955
|
Mean ± SD.
|
41.0 ± 48.1
|
49.7 ± 64.9
|
Vit D
|
|
|
|
|
Normal
|
29 (100%)
|
76 (72.4%)
|
χ2=10.222*
|
0.001*
|
Low
|
0 (0%)
|
29 (27.6%)
|
NSAIDs
|
1 (3.4%)
|
14 (13.3%)
|
χ2=2.234
|
0.190
|
ASA
|
3 (10.3%)
|
25 (23.8%)
|
χ2=2.492
|
0.114
|
Antithrombotic
|
1 (3.4%)
|
10 (9.5%)
|
χ2=1.113
|
0.455
|
Steroids
|
0 (0%)
|
3(75%)
|
χ2=13.359*
|
0.004*
|
c2: Chi square test t: Student t-test U: Mann Whitney test p: p value for comparing between the two studied groups
*: Statistically significant at p ≤ 0.05
Table (2): Comparison of the clinical course and severity of disease process between the two groups
|
Young group (<50)
|
Old group (≥50)
|
|
|
Salinnen stage
|
(n= 27)
|
(n= 88)
|
|
|
1
|
21 (77.8%)
|
56 (63.6%)
|
χ2=1.867
|
0.172
|
2 – 3
|
6 (22.2%)
|
24 (27.3%)
|
χ2=0.273
|
0.601
|
4 – 5
|
0 (0%)
|
8 (9.1%)
|
χ2=2.638
|
0.195
|
Inpatient/Outpatient
|
(n = 29)
|
(n = 105)
|
|
|
Inpatient
|
18(62.1%)
|
73(69.5%)
|
χ2=0.580
|
0.447
|
Outpatient
|
11(37.9%)
|
32(30.5%)
|
Antibiotics
|
16 (55.2%)
|
63 (60 %)
|
χ2=0.219
|
0.640
|
Guided drainage
|
3 (10.3%)
|
11 (10.5%)
|
χ2=0.0
|
1.000
|
Lap Lavage
|
2 (6.9%)
|
3 (2.9%)
|
χ2=1.032
|
0.296
|
Surgery
|
2 (6.9%)
|
13(12.4%)
|
χ2=0.688
|
0.523
|
Type of surgery
|
(n = 29)
|
(n = 105)
|
|
|
No
|
28(96.6%)
|
92(87.6%)
|
χ2=1.833
|
0.449
|
Hartmann’s procedure
|
1(3.4%)
|
12(11.4%)
|
Total colectomy
|
0(0%)
|
1(1%)
|
Hospital stay (days)
|
(n = 29)
|
(n = 105)
|
|
|
No
|
10 (34.5%)
|
33 (31.4%)
|
χ2=0.097
|
0.755
|
Yes
|
19 (65.5%)
|
72 (68.6%)
|
Median (Min. – Max.)
|
5 (2 – 10)
|
5(1 – 33)
|
U= 606.5
|
0.442
|
Mean ± SD.
|
4.5 ± 2.6
|
7.1 ± 7
|
Recurrence
|
12 (41.4%)
|
24 (22.9%)
|
χ2=3.968*
|
0.046*
|
c2: Chi square test U: Mann Whitney test p: p value for comparing between the studied groups
*: Statistically significant at p ≤ 0.05