title: Predictors of severity in ischaemic colitis.
abstract: OBJECTIVE
  Ischaemic colitis (IC) is an inadequate perfusion leading to potentially life-threatening colonic inflammation. The aim was to identify patient characteristics that predict severity in biopsy-confirmed IC.
  
  
  METHODS
  A retrospective study of consecutive patients admitted with a robust diagnosis of IC over a 5-year period was performed. As IC is often misdiagnosed, strict inclusion criteria including supporting histopathology, exclusion of inflammatory bowel disease, absence of recent antibiotics or negative stool sampling with testing for Clostridium difficile were adhered to. Due to differing pathophysiology involved, patients suffering IC due to injury to colonic perfusion from vascular procedures or tumours were also excluded. Patients were divided by outcomes into a severe IC group including those that needed surgery or suffered mortality and a non-severe IC group that included patients managed medically with good evolution during their index admission. Patient characteristics were analysed to identify statistically significant predictors of severity (p < 0.05).
  
  
  RESULTS
  Thirty-two patients (11 males, 21 females; mean age 72.5) met the inclusion criteria. Medical management was adopted in 23 patients with a single mortality (4.3%). Nine patients were managed surgically with two mortalities (22.2%), giving an overall mortality of 9.4% and a severe IC group consisting of ten patients. Significant prognostic predictors of severity included: right-sided IC (p = 0.0002), guarding (p = 0.001), lack of bleeding per rectum (p = 0.005) and chronic constipation (p = 0.02).
  
  
  CONCLUSIONS
  The majority of patients with IC can be managed conservatively. Right-sided IC, guarding, lack of bleeding per rectum and chronic constipation are associated with severe IC.
authors.affiliation: Department of Surgery, Queen Margaret Hospital, Dunfermline, NHS Fife, UK. stephenoneill@doctors.org.uk
authors.forename: Stephen
authors.initials: S
authors.lastname: O'Neill
authors.forename: Kenny
authors.initials: K
authors.lastname: Elder
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Harrison
authors.forename: Satheesh
authors.initials: S
authors.lastname: Yalamarthi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017091:Colitis, Ischemic / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology