Mortality Risk Increased in Colonic Diverticular Disease: A Nationwide Cohort Study
Hightlights
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WHAT IS KNOWN
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In colonic diverticular disease, progression to diverticulitis is associated with the risk of both morbidity and mortality.
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Mortality in colonic diverticular disease patients is attributed to acute complications including sepsis and hemorrhage.
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The importance of non-GI diseases contributing to mortality in colonic diverticular disease is uncertain.
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Whether non-diverticulitis colonic inflammation contributes to the mortality of colonic diverticular disease is unknown.
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WHAT IS NEW HERE
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Colonic diverticular disease is associated with a small excess mortality, both compared to the general population and compared to siblings.
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The presence of histological mucosal inflammation on colorectal biopsy in patients diagnosed with colonic diverticular disease is a predictor of an increased risk of mortality, particularly in the 1st year of follow-up.
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WHAT DOES THIS STUDY ADD TO THE LITERATURE?
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This study provides novel evidence that mucosal inflammation as seen on histological biopsies in patients with colonic diverticular disease, increases the risk of mortality, especially within the first year of follow-up. It may be important for clinicians to identify patients with colonic diverticular disease who have histopathological identified mucosal inflammation, but whether follow-up care and disease management would alter this risk is unknown.
ABSTRACT
INTRODUCTION
There are limited population cohort data on overall and cause-specific mortality in colonic diverticular disease.
OBJECTIVE
To measure overall and cause-specific mortality in colonic diverticular disease, compared to matched reference individuals and siblings.
METHODS
A population-based retrospective cohort study (“the ESPRESSO study”) was conducted in Sweden. There were 97 850 cases with a medical diagnosis of diverticular disease (defined by inpatient or outpatient international classification of disease (ICD) codes) and colorectal histology identified in 1987-2017 from histopathology reports. The mortality risk between individuals with colonic diverticular disease and age, sex, and country, matched reference individuals (n=453 634) from the general population, as well as siblings of the cases (n=84 197) was determined. Cox regression models adjusted for comorbidity estimated hazard ratios (HRs) for all-cause mortality.
RESULTS
During the period of follow-up, there were 32 959 deaths in individuals with colonic diverticular disease (44/1000 person-years) compared with 127 153 in matched reference individuals (34/1000 person-years), resulting in an HR of 1.27 (95%CI 1.25-1.29). Also compared to siblings, colonic diverticular disease patients were at increased risk of death, HR 1.39 (95%CI 1.33-1.45). Non-GI deaths that occurred over the study period were also contributed to by cancer, respiratory and cardiovascular disease. Mortality risks were further increased in colonic diverticular disease patients with a colorectal biopsy showing any mucosal inflammation HR 1.36; (95%CI 1.33-1.38), with the most significant increase during the first year after diagnosis HR 2.18; (95%CI 2.05-2.32).
CONCLUSIONS
Mortality in colonic diverticular disease is increased over reference individuals in the general population. The presence of mucosal inflammation on colorectal biopsies in histopathology reports of patients recently diagnosed with colonic diverticular disease is a predictor of increased risk of mortality.
LEGGI TUTTO
