RISK FACTORS FOR ENDOSCOPICALLY SEVERE ISCHEMIC COLITIS (IC)

Aims IC is a relatively common disease caused by a transient colonic hypoperfusion. Aims of this study were to identify risk factors for endoscopic severity, and show epidemiology, clinical presentation, endoscopic findings and outcomes of IC.

Methods This is a single-center retrospective analysis of consecutive patients diagnosed from January 2013 to December 2018. All patients underwent colonoscopy. According to endoscopy, IC was scored as grade 1 (hyperemia, < 1 cm erosions and non-confluent ulcers), grade 2 (> 1 cm superficial, partially-confluent ulcers) and grade 3 (deep/diffuse ulcers or necrosis). To compare homogenous groups and analyze clinical or prognostic differences, IC were grouped into “minor ulcers” (Group A; grade 1) and “major ulcers” (Group B; grade 2 and 3).

Results 227 patients (M:F = 60:167) were included. Average age was 72.7 years old (SD ± 16.2). Risk factors associated with IC were hypertension (63.4%), ischemic vascular disease (35.8%), dyslipidemia (28.6%) and diabetes (13.2%). 11% of patients had a previous history of IC. Clinical presentation was rectal bleeding (85.5%), abdominal pain (83.3%), diarrhea (53.3%) and constipation (3%). 40% experienced “triad symptoms” (sudden cramping abdominal pain, urgent desire to defecate, bloody diarrhea). IC were scored as grade 1 in 60.4%, grade 2 in 27.3% and grade 3 in the remaining 12.3%. IC involved sigmoid colon and rectum in 30.4% and descending and proximal colon in 55.5% and 14.1% patients, respectively. Median length of stay was 5.2 days (range 3–11). No surgery recorded. Death occurred in 1.3%. At univariate analysis, patient’s factors associated with endoscopic high-grade IC (Group B) were age (p = 0.09), diabetes (p = 0.09) and leukocytosis or creatinine ≥ 1.5 mg/dL at hospital admission (p = 0.032). At multivariable, leukocytosis and creatinine remained significantly associated with high-grade IC (ORs, 1.92; 95% CI:1.07–3.52; p = 0.030).

Conclusions Elevation of creatinine and leucocyte at hospital admission seem related with severe IC and might be used to stratify patients.