Predicting Diverticulitis Risk With DICA Classification and CODA Score

intestinal diverticuli
A team of researchers sought to determine the predictive value of DICA classification and CODA score for clinical outcomes of diverticulosis.

The Combined Overview on Diverticular Assessment (CODA) score was found to significantly enhance the predictive value of the Diverticular Inflammation and Complication Assessment (DICA) classification for determining risk for diverticulitis and surgery, according to study results published in Gut.

Researchers conducted a multicenter, prospective, international cohort study to evaluate prognostic performance of DICA endoscopic classifications and to develop a novel predictive score, CODA, using data from 35 centers in Italy and England. Data for an external validation cohort were sourced from 8 centers in Poland, Romania, Lithuania, Brazil, and Venezuela. The predictive power of CODA was evaluated for diverticulitis and surgery due to complications of diverticulitis.

The overall study cohort (N=2198) had a median age of 66 (IQR, 58-74) years, 48.3% were men, and Charlson comorbidity score was 3 (IQR, 2-4).

The DICA classification score comprised 4 endoscopic items, and patients were classified as DICA 1 (up to 3 points; n=1370), DICA 2 (4-7 points; n=594), and DICA 3 (>7 points; n=234). Patients with higher DICA classification were older (P =.0073) and more had Charlson comorbidity scores greater than 3 (P =.025).

The derivation (n=1732) and validation (n=466) cohorts differed significantly for nearly all baseline characteristics.

During the study period, 162 diverticulitis events (cumulative incidence, 26.3 per 1000 person-years) and 43 surgeries due to complications (cumulative incidence, 7.0 per 1000 person-years) occurred.

Compared with DICA 1, diverticulitis risk was associated with DICA 2 (hazard ratio [HR], 3.62; 95% CI, 2.49-5.30) and DICA 3 (HR, 7.45; 95% CI, 4.98-11.1). Similarly, DICA 2 (HR, 20.3; 95% CI, 4.70-88.1) and DICA 3 (HR, 77.3; 95% CI, 18.3-327) were associated with increased risk for surgery due to complications.

Among all potential predictors, the final CODA score comprised DICA score (b, 0.9210; 95% CI, 0.6825-1.159; P <.0001), abdominal pain score (b, 0.1342; 95% CI, 0.6943-0.1990; P <.0001), and age 65 years and older (b, -0.5491; 95% CI, -0.8974 to -0.2008; P =.0020).

The CODA score was calculated as the sum of DICA score (DICA 1, 7 points; DICA 2, 14 points; DICA 3, 21 points), abdominal pain score (1 point per score, range 1-10), and age (³65 years, -4 points; <65 years, 0 points).

Patients with CODA score 10 to 16 (HR, 4.09; 95% CI, 2.33-7.21; P <.001) and 16 to 31 (HR, 10.2; 95% CI, 6.01-17.3; P <.001) points were associated with increased 3-year risk for diverticulitis. Similarly, patients with intermediate (HR, 18.4; 95% CI, 2.37-142; P =.005) and high (HR, 58.0; 95% CI, 7.85-428; P <.001) CODA scores were associated with increased risk for surgery due to complications.

The study was limited by the small number of diverticulitis occurrences among the cohort.

“…DICA endoscopic classification is a predictor of outcomes of diverticular disease,” the study authors wrote. “The CODA score combines DICA and few clinical parameters, and may reliably predict the occurrence of acute diverticulitis and surgery due to complications, thus providing a new risk stratification tool useful for daily clinical practice.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original reference for a full list of disclosures.


Tursi A, Brandimarte G, Di Mario F, et al. Prognostic performance of the ‘DICA’ endoscopic classification and the ‘CODA’ score in predicting clinical outcomes of diverticular disease: an international, multicentre, prospective cohort study. Gut. Published online June 7, 2022. doi:10.1136/gutjnl-2021-325574