title: High mortality of cocaine-related ischemic colitis: a hybrid cohort/case-control study.
abstract: BACKGROUND
  Isolated case reports describe bowel ischemia in cocaine users, and the optimal management of these patients remains uncertain.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Teaching hospitals.
  
  
  METHODS
  Patients hospitalized for colonic ischemia related to cocaine compared with noncocaine-related ischemic colitis. Cases were identified by using ICD-9 codes and laboratory urine toxicology tests. Patients were included if they had a confirmed diagnosis of bowel ischemia by CT, colonoscopy, angiography, or, in the case of emergency exploration, a pathology report showing bowel ischemia and a urine toxicology test that was positive for cocaine. Controls were individuals who met the same criteria but had no history of cocaine use and a urine test negative for cocaine. Charts were individually audited for accuracy of coding.
  
  
  METHODS
  Mortality and its risk factors.
  
  
  RESULTS
  Patients with cocaine-related ischemia were significantly younger and had a significantly (P < .05) higher mortality rate than patients with ischemic colitis unrelated to cocaine (cocaine: 5/19 [26%] and noncocaine: 6/78 [7.7%]). The cause of death in all cases was septic shock caused by extensive bowel ischemia. Multivariate logistic regression analysis showed that cocaine-related ischemic colitis was a significant risk factor for mortality (odds ratio 5.77; 95% CI, 1.37-24.39) as was the need for surgical intervention (odds ratio 4.95; 95% CI, 1.22-20.12).
  
  
  CONCLUSIONS
  Retrospective design.
  
  
  CONCLUSIONS
  Cocaine-related ischemic colitis has a high mortality. In young patients presenting with acute abdominal pain and/or rectal bleeding with evidence of bowel wall thickening or pneumatosis on imaging studies or colonoscopy, cocaine-related ischemia should be considered. Testing for cocaine use may help identify patients at high risk of sepsis and death.
authors.affiliation: Aurora Sinai Medical Center, Milwaukee, WI 53066, USA.
authors.forename: Moshen
authors.initials: M
authors.lastname: Elramah
authors.forename: Michael
authors.initials: M
authors.lastname: Einstein
authors.forename: Naoyo
authors.initials: N
authors.lastname: Mori
authors.forename: Nimish
authors.initials: N
authors.lastname: Vakil
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000150:complications*; D017091:Colitis, Ischemic / Q000139:chemically induced* / Q000150:complications / Q000401:mortality*; D003113:Colonoscopy; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012772:Shock, Septic / Q000209:etiology*
chemical_list: D003042:Cocaine