The Predictors of Poor Outcomes of Ischemic Colitis, Including the Severity of Histopathological Features: A Four-Year Chart Review of 74 Consecutive Cases

Purpose Ischemic Colitis (IC) can be transient or it can have evolving presentations that have a profound impact on outcome. Based on a chart review of cases, the aim of the study was to characterize the prevailing histological features of IC and to determine to what extent the severity of necrosis affected outcomes.Methods: We conducted a retrospective study of patients with IC who were referred to our department of surgery from 2013 to 2016. Moreover, the relationships among IC presentations, comorbidities and surgical procedures were surveyed. The severity of necrosis was investigated as the main histological feature, and a morphological criterion was used to grade necrosis from mild to severe differences between groups were determined with a univariate analysis, variables predicting death with a multivariate analysis and a flow-chart identifying clinical behavior.Results: Among 82 patients with an IC diagnosis, 74 (90.3%) were referred for surgical consultation, and 8 (9.7%) patients were not because they had fulminant IC. Comorbidities affected 53 (71.6%) patients. Ten (13.5%) patients underwent surgery, all of whom had severe necrosis, and 6 (60%) died perioperatively. The severity of necrosis impacted whether surgery was performed for evolving forms of IC (OR: 9.4, 95% CI: 1.8-48.8, p=0.002), the number of patients who had died by follow-up (OR: 0.2, 95% CI: 0.08 to 0.7, p=0.013), and the frequency of right-sided IC (χ-square 12.4, p=0.029); however, necrosis severity was not affected by the presence of comorbidities (OR: 2.2, 95% CI: 0.724 to 7.124, p=0.154). Advanced age (OR: 1.119, 95% CI 1.015 to 1.234, P=0.023) and need of surgery predicted death (OR: 5.597, 95% CI 1.125 to 27.842, P=0.035). Conclusion: This study quantified to what extent the severity of histological findings affected poor outcomes and what factors predicted death. These findings allowed us to suggest prophylactic therapies for transient form of IC.