Characteristics of Severe versus Non-Severe Ischemic Colitis: A Multicenter Community Study

Abstract

Purpose: Ischemic colitis (IC) carries a low mortality and is usually treated conservatively. Patient characteristics vary widely in patients with severe IC. The aim of this study was to investigate patient characteristics of IC in the community setting. Methods: Medical records of patients with IC from January, 2007 to January, 2013 were reviewed. The study was conducted in two community hospitals. Demographics, clinical features, lab studies, imaging, histologic, endoscopic features, comorbidities, concomitant use of medications, surgery, hospital stay, and death <30 days were collected. The patients were divided into two groups (GpA: severe IC; GpB: nonsevere IC). Severe IC was defined as IC that required surgery or caused death <30 days of the diagnosis. Inclusion criteria: IC confirmed by clinical findings, radiographic, endoscopic and histologic findings, or negative stool studies for infection. Exclusion criteria: age <18 years, pregnancy, positive studies for pathogens in stool, or colonic ischemia due to mechanical causes. Results: One hundred eighteen IC patients were included (mean age 69.4 years), 98 females (83%). Fifteen patients (12.7%) in GpA, and 103 (87.3%) in GpB. Mean age in GpA was 76.5 years and in Gp B 68.4 years. While abdominal distension and peritoneal signs were frequent in GpA (p=0.009; p=0.002), rectal bleeding was common in GpB (p<0.0001). Other clinical features were not significant between the groups. Glucose, WBC, and amylase levels were higher in GpA vs. GpB (p=0.0358, p=0.0202, and p=0.0091, respectively). Colonic wall thickening and pericolonic fat stranding on CT were less frequent in GpA vs. GpB (p<0.0001 and 0.004, respectively). Bowel dilation, pneumatosis coli, and portal/mesenteric venous air were more often seen in GpA (p=0.003, p<0.0001, and p<0.001, respectively). History of atrial fibrillation was the only comorbidity associated with GpA (p=0.001). Involvement of right colon was associated with GpA (p=0.002). Use of 12 categories of medications showed no drug association with GpA (p>0.05 for all). There were no specific colonoscopic findings that predicted severe IC (p>0.05 for all). On histology, the mucosal and transmural infarction was more often in GpA (p=0.004). Length of hospital stay was longer in GpA vs. GpB (18.3 days vs 4.9 days; p<0.0001). Patients in GpA required ICU and mechanical ventilation more often than GpB (p<0.0001 for both). Conclusion: In this retrospective study from the community setting, severe IC occurred in 12.7% of patients and they were older. Higher glucose, WBC, and amylase levels were predictors of severe IC. Involvement of the right colon and history of atrial fibrillation were associated features of severe IC. Further studies on a larger population are needed from community setting to further understand these characteristics.