Nonocclusive Ischemic Colitis: Analysis of Risk Factors for Severity

Abstract

The purpose of this study was to identify risk factors predictive of severe nonocclussive ischemic colitis (IC) requiring operation or resulting in mortality. One hundred seventeen patients with nonocclussive IC were identified and divided into two groups: those with severe disease (n = 24) and those with disease that resolved with supportive care (n = 93). Univariate and multivariate logistic regression models were used. The splenic flexure was the most common involved segment (57.3%), whereas the right colon was involved in 17.9 per cent of patients. Multivariate logistic regression identified three independent risk factors for severe disease: leukocytosis greater than 15 3 109/L (odds ratio [OR], 5.7; confidence interval [CI], 1.5 to 21), hematocrit less than 35 per cent (OR, 4.5; CI, 1.1 to 17), and history of atrial fibrillation (OR, 15; CI, 1.3 to 190). Right-sided IC and chronic renal insufficiency did not affect severity. Special attention should be given to patients with the following risk factors for a severe course: atrial fibrillation, elevated white blood cell count, and anemia. These factors might enable earlier identification of patients who may benefit from early operation. Further prospective studies focusing on subgroups of IC (occlusive and nonocclusive) are required.

The predictors of the severity of ischaemic colitis: a systematic review of 2823 patients from 22 studies

“…Some studies, however, have not found a worse prognosis amongst patients with right colonic involvement , which might be explained by clinical heterogeneity. For example, in the study by Won Chung et al .…”

“…Two studies suggested that extensive or whole colonic lesions , a history of atrial fibrillation , onset of IC whilst an inpatient and anaemia were poor prognostic factors. Among the 22 patients in the study by Arnott et al .…”

“…Because of the differing pathophysiology involved, papers describing IC resulting from a single aetiology due to vascular procedures, trauma, mesenteric ischaemia, colonic carcinoma, colorectal neoplasia or medication were also excluded. The term severe IC was defined as the need for surgical treatment or death among the included studies .…”

Ischaemic colitis: practical challenges and evidence-based recommendations for management

“…Coexistent atrial fibrillation21 and atherosclerotic disease4 promotes less favourable outcomes. Older patients and those with chronic obstructive pulmonary disease (COPD) also tend to have poorer outcomes,4 the latter likely owing in part to the cardiovascular sequelae of smoking.…”

“…Older patients and those with chronic obstructive pulmonary disease (COPD) also tend to have poorer outcomes,4 the latter likely owing in part to the cardiovascular sequelae of smoking. Other negative prognostic factors include CKD,5 11 thrombocytopaenia,5 high C-reactive protein (CRP)5 and high white cell count (WCC) 21. Unsurprisingly, examination findings of guarding or peritonism are linked to a poorer prognosis 15 16…”