Ischemic Colitis: Characteristics and Predictive Factors of Severity, in Hospital Mortality and Relapse

ABSTRACT

Objective:

The study was designed to describe a cohort of patients with ischemic colitis (I.C.) that required admission and the factors related to severity and mortality. Also, we tried to define the risk of relapse after discharge and the variables associated.

Methods:

Descriptive and retrospective study of patients with I.C. diagnosed between January 1996 and March 2003. Qualitative variables were analyzed using Fisher exact test and parametric variables were analyzed using Student´s t-test. Those variables statistically significant were included in a Cox regression model.

Results:

During the study period, 169 patients with I.C. were admitted into hospital. Ten patients required surgery, 8 patients died and 13 were considered severe. The variables independently associated to severity were: cerebrovascular disease (OR: 6.63, 95% CI: 1.59-27.61, p: 0.009), absence of hematochezia (OR: 4.43, 95% CI: 1.12-17.47, p: 0.033), abdominal distention (OR 6.39, 95% CI: 1.65-24.70, p: 0.007) and ileus (OR 8.76, 95% CI: 2.12-36.06, p: 0.003). Only diffuse peritonism was associated to mortality (OR: 26.07, 95% CI: 5.67-119.93, p<0.001). After discharge, seven (4.5%) patients had a relapse (mean time: 5.31t3.67 months), with a stricture in 6 of them. A second episode of I.C. (OR: 13.21, 95% CI: 2.52-69.28, p: 0.002), treatment with aspirin (OR 6.41, 95% CI: 1.12-36.64, p: 0.037) and with antihypertensive drugs (OR 0.089, 95% CI: 0.01-0.754, p: 0.027) were independently associated to relapse.

Conclusions:

We identified several predictive factors that can be used to stratify patients on admission. We found a relation between treatment with aspirin, antihypertensive drugs and relapse that should be confirmed in prospective studies.

Keywords:

Ischemic colitis, cerebrovascular disorders, hematochezia, peritonism, aspirin, antihypertensive agents.