Ischemic colitis in the elderly: Predictors of the disease and prognostic factors to negative outcome

Abstract

Objective. Ischemic colitis (IC) poses a challenge for physicians, especially in elderly patients. The aim of this study was to identify predictors of the disease and to assess the factors predicting its evolution in elderly people. Material and methods. A retrospective study was undertaken in patients with IC admitted to Padua General Hospital between 2003 and 2008. Only patients with biopsy-proven IC were considered. Fifty control subjects were randomly selected from those seen at our units for acute geriatric disease during the same interval. Patients with IC were classified as having either a positive or negative outcome. Results. A total of 46 patients were considered. The risk factors for IC identified from univariate analysis were analyzed in a multivariate logistic regression model and constipation [adjusted odds ratio (OR) 4.8; 95% confidence interval (CI) 1.1–20.1], vasculopathy (OR 4.9; 95% CI 1.4–16.6), hepatitis C virus (HCV) (OR 9.9; 95% CI 1.1–92.9) and cancer (OR 7.5; 95% CI 2.1–26.9) confirmed their independent significance as risk factors. Hematochezia was predictive of a positive outcome (OR 0.07; 95% CI 0.02–0.40), while cancer (OR 3.2; 95% CI 1.2–11.9), HCV positivity (OR 9.6; 95% CI 1.6–56.5), signs of peritonism (OR 4.7; 95% CI 1.2–18.4), localization in the right colon (OR 5.75; 95% CI 1.5–21.9) and increased levels of lactate dehydrogenase (LDH) and urea were independently predictive of a negative outcome. Conclusions. Elderly patients with IC are characterized by significant comorbidities. The absence of hematochezia and the presence of a concomitant malignancy, HCV, a marked increase in urea and LDH and disease involving only the right colon are factors that may predict a negative outcome in elderly patients.