Background __and objective_:
The Diverticular Inflammation and Complication Assessment (DICA) classification and the Combined Overview on Diverticular Assessment (CODA) score are valuable prognostic tools for diverticulitis, providing new risk stratification tools useful for everyday clinical practice and also with a significant public health impact in terms of treatment effectiveness and decision making. Our aim was to assess the net benefit of management strategies based on DICA and CODA and to see whether fecal calprotectin (FC) can further aid improving risk stratification.

_Methods_:
871 participants with diverticular disease who underwent FC dosing were included in this international, multicentre, prospective cohort study. Survival methods for censored observations were used to estimate the 3-year risk of diverticulitis according to basal FC, DICA and CODA. The net benefit of management strategies based on DICA, CODA, and FC in addition to CODA, was assessed with decision curve analysis.

_Results_:
FC was associated with the risk of diverticulitis at 3 years (HR per each base 10 logarithm increase: 3.29; 95% CI, 2.13−5.10) and showed moderate discrimination (c-statistic: 0.685; 0.614−0.756). DICA and CODA were more accurate predictors of diverticulitis than FC. However, FC showed high discrimination capacity to predict acute diverticulitis at 3 months, which was not maintained at longer follow-up times. A decision curve analysis, which incorporates the harms and benefits of using a prognostic model for clinical decisions, comparing the combination of FC and CODA with CODA alone did not clearly indicate a larger net benefit of one strategy over the other.

_Conclusion_:
CF could be useful as a complementary tool to evaluate the early risk of diverticulitis in patients with long-standing diverticular disease in whom performing further colonoscopy is considered inconvenient or not feasible. In all other cases, management strategies based on the CODA score alone should be suggested.