Evlatuation of prognostic factors in patients with ischemic colitis: Single center experience

Introduction: Ischemic colitis is an important gastrointestinal system disease that is frequently seen in elderly patients. Delays in diagnosis and determination of disease severity cause increased morbidity and mortality in patients. However, only a few studies on the possible relation of factors with the progression to severe colitis are available and these factors have differed across studies. In this study, new and more sensitive factors that can predict the disease severity in diagnosed with ischemic colitis were investigated. Materials and Methods: This is a retrospective cross-sectional study. 101 patients diagnosed with ischemic colitis in Dokuz Eylul University Gastroenterology Department between July 2014 and July 2022 were included in the study. Modified Brandt and Boley criteria were used in the diagnosis of ischemic colitis. Patients were divided into mild and severe groups. Patients in the mild group were defined as those who improved with only conservative treatment, whereas patients in the severe group were defined as those who needed surgical treatments or died. Demographic, clinical, laboratory, imaging and endoscopic characteristic of the patients were examined and the groups were compared. Results: 101 patients enrolled in this study. Among them the mild group had 78 patients (77,2%) and the severe group, 23 patients (22,8%). No statistically significant relationship was found between age, gender and disease severity. In the comparison made according to comorbidity, diabetes was found more common in the severe group (p=0,049). ROC analysis performed for the predictive values of laboratory parameters for several disease and Neutrophil to Lymphocyte Ratio (69,6% sensitivity 59% specificity cut-off:7,50 AUC: 0.648 95%CI: 0.513 0.783 p=0.032) , Platelet to Lymphocyte Ratio (82.6% sensitivity 47% spesificity cut-off:150,4 AUC:0,635 95%CI:0,501-0,770 p=0,049) and LDH to Albumin Ratio (65,2% sensitivity 84,6% spesificity cut-off:121,3 AUC:0,793 95%CI:0,684-0,903 p=<0,001) showed significant results in demonstraiting the risk. In the multivariate regression analysis, BUN level >20.9 mg/dl [OR=9.8 95%CI (1.4-32.5) p=0.016] and serum albumin level <2.46 mg/dl [ OR=5.1 95%CI (1.1-24.6) p=0.043] were found to be the most important risk factors for severe disease. Conclusion: We found diabetes and laboratory parameters such as NLR, PLR, LAR, BUN and albumin have an important role in determining the prognosis of ischemic colitis. Considering the fact that treatment of ischemic colitis is determined according to severity of the disease and the early surgery in severe cases is associated with lower risk of morbidity or mortality, usage of this parameters, which can be available in almost every hospital, in evaluating the prognosis will greatly contribute to disease management. Keywords: Colitis, ischemia, colonoscopy, prognosis, surgery, mortality