Cirrhosis Is Associated With Worse Outcomes in Ischemic Colitis: A Nationwide Retrospective Study

Then, Eric O.; Lund, C; Uhlenhopp, Dustin; Sunkara, Tagore; Gaduputi, Vinaya

doi:10.14740/gr1339

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…This retrospective study is the first to evaluate the effect of CHF on outcomes in hospitalized patients with IC. Our results are concordant compared to similarly designed studies that examined COPD and cirrhosis instead of CHF [5,6]. Furthermore, the findings suggest that patients with IC will suffer worse outcomes, including higher mortality, colectomy rates, length of stay, and costs if carrying a co-diagnosis of CHF.…”

Section: Discussionsupporting

confidence: 79%

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Congestive Heart Failure Is Associated With Worse Outcomes in Patients With Ischemic Colitis: A Nationwide Study

Mahfouz¹,

Kozai²,

Obeidat³

et al. 2022

Cureus

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Introduction: Ischemic colitis (IC) results from compromised blood flow to the colon. Risk factors include atrial fibrillation (A.Fib), peripheral artery disease (PAD), coronary artery disease (CAD), and congestive heart failure (CHF). However, few studies compared the mortality rate and colectomy between patients with IC with CHF and IC alone.Objective: We aim to investigate the possibility of worse outcomes in patients with IC and CHF compared to IC alone.Methodology: Using the National Inpatient Sample database from 2016 to 2019, we obtained baseline demographic data, total hospital charge, rate of colectomy, length of hospital stay (LOS), and in-hospital mortality. Data were compared using a t-test and chi-squared. Odds ratios for comorbidities including A.Fib, CAD, PAD, end-stage renal disease, chronic obstructive pulmonary disease, hyperlipidemia, hypertension, diabetes, and cirrhosis were calculated.Results: 106,705 patients with IC were identified, among which 15,220 patients also had CHF. IC patients with CHF had a longer LOS (6.6 days vs 4.4 days; P<0.0001), higher total hospital charge ($71,359 vs $45,176; P<0.0001), higher mortality rate (8.5% vs 2.9%; P<0.0001), and higher colectomy rate (9.2% vs 5.9%; P<0.0001).Conclusion: CHF is associated with poor outcomes in patients with IC. Our study showed an increased risk of mortality and colectomy compared to patients with IC alone. The findings suggest it may be warranted to have a heightened clinical suspicion of IC in patients with CHF who present with bleeding per rectum.

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Section: Discussionsupporting

confidence: 79%

“…Previous studies have concluded a higher risk of mortality and colectomy rates in patients with IC who also have significant comorbidities such as cirrhosis and chronic obstructive pulmonary disease (COPD) [5,6]. However, there are no studies that have examined the relationship between IC and CHF.…”

Section: Introductionmentioning

confidence: 99%

Congestive Heart Failure Is Associated With Worse Outcomes in Patients With Ischemic Colitis: A Nationwide Study

Mahfouz¹,

Kozai²,

Obeidat³

et al. 2022

Cureus

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“…The disturbance in the anticoagulant and procoagulant reactions in liver cirrhosis triggers clot formation or excessive bleeding [ 29 ]. The portal hypertensive colopathy manifests with rectal varices, colonic vascular ectasias, non-specific inflammatory changes, and hemorrhoids [ 30 - 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…The other manifestations include mild chronic inflammatory infiltrates, edema of lamina propria, and irregular thickening in dilated tortuous mucosal capillaries [ 32 ]. A retrospective study by Then et al revealed a higher mortality rate (i.e.,10.7%), increased total hospital charge (i.e., USD 84,769), and longer length of stay (i.e.,7.3 days) in patients with ischemic colitis and history of cirrhosis [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Lactulose-Induced Ischemic Colitis: A Rare Presentation and an Overview of Possible Etiologies of the Disease

Umar¹,

Ilyas²,

Shah³

et al. 2022

Cureus

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Ischemic colitis is one of the most common ischemic pathologies of the gastrointestinal system and can be divided into non-gangrenous and gangrenous forms. The pathophysiology involves restricted blood supply to the colonic mucosa. Several risk factors have been implicated in the development of ischemic colitis. Lactulose, one of the mainstay therapies for the treatment of hepatic encephalopathy in patients with cirrhosis, has been rarely reported as a cause of ischemic colitis. To the best of our knowledge, there has been only one case report associating lactulose use with the development of ischemic colitis. The exact pathophysiology is unknown but might be associated with the fermentation of lactulose by intestinal bacteria, causing gaseous distention and increasing the intraluminal pressure. We present the case of a 77-year-old African American male, a known case of non-alcoholic liver cirrhosis with portal hypertension and esophageal varices, brought in by his family to the emergency department for altered mental status, non-bilious vomiting, abdominal distension, and pain for one day. On physical examination, the patient had upper extremity asterixis and was alert but disoriented to place and person. Diagnostic paracentesis was performed, which revealed leukocytosis, predominantly neutrophils. The patient was admitted for spontaneous bacterial peritonitis and hepatic encephalopathy with decompensated liver cirrhosis. The patient was started lactulose with a goal of three to four bowel movements per day. Despite adequate treatment, the patient continued to develop worsening mental function and abdominal distension. This was later followed by a bloody bowel movement. Laboratory assessment showed an elevated white blood cell count, worsening kidney function, and high anion gap metabolic acidosis. CT scan revealed dilated loops of bowel with air and fluid along with submucosal wall edema, findings suggestive of ischemic colitis. Given the poor prognosis and the patient's condition, colonoscopy was deferred. Lactulose was discontinued, as it was thought to be a contributing cause of the patient's ischemic colitis. His condition continued to deteriorate, and he passed away on Day 18 of admission.

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“…A combination of IRCI and AMI is associated with even worse outcomes [68,69]. Medical comorbidities, such as cirrhosis [70] and COPD [71], additionally, are risk factors for colectomy and/or mortality. Also, medications, such as aspirin, have been associated with increased ulceration and worsened outcomes [72 ▪ ].…”

Section: Managementmentioning

confidence: 99%

Bad blood: ischemic conditions of the large bowel

Rizwan

Feuerstadt

2021

Current Opinion in Gastroenterology

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Purpose of reviewColon ischemia is the most common form of intestinal ischemic injury and is seen frequently in an elderly population. This disease is usually self-limited, and many causes have been identified. The recent literature has focused on estimates of prognosis, triaging appropriate level of care, and identification of optimal treatments. In this review, we will address our current understanding of colon ischemia including epidemiology, pathophysiology, segmental distribution, presentation, diagnosis, and management. Recent findingsResearch has recently been focused on factors associated with poor outcome. The medical comorbidities identified include chronic obstructive pulmonary disease (COPD), hepatic cirrhosis, and chronic aspirin use. Serological markers are noninvasive tools that can triage severity. Recent studies have shown procalcitonin, C-reactive protein, D-dimer, and neutrophil counts can help predict those at greatest risk for poor outcome. The timing of colonoscopy relative to symptomatic onset also can help predict severity. Early colonoscopy allows for quicker identification of ischemic stigmata, reducing the chance of misdiagnosis and potentially unnecessary and harmful treatment. The treatment of colon ischemia has classically been conservative with antimicrobials reserved for those with moderate or severe disease. Recent retrospective analysis calls into question the utility of antibiotics in the treatment of colon ischemia, although the data is not convincing enough to advise against antimicrobial treatment in patients with severe and fulminant disease.

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Cirrhosis Is Associated With Worse Outcomes in Ischemic Colitis: A Nationwide Retrospective Study

Cited by 4 publications

References 19 publications

Congestive Heart Failure Is Associated With Worse Outcomes in Patients With Ischemic Colitis: A Nationwide Study

Congestive Heart Failure Is Associated With Worse Outcomes in Patients With Ischemic Colitis: A Nationwide Study

Lactulose-Induced Ischemic Colitis: A Rare Presentation and an Overview of Possible Etiologies of the Disease

Bad blood: ischemic conditions of the large bowel

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