Then Eric, Lund Caitlin, Uhlenhopp Dustin J, Sunkara Tagore, Gaduputi Vinaya
Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center - Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA.
Department of General Surgery, MercyOne Des Moines Medical Center, Des Moines, IA, USA.
Gastroenterology Res. 2020 Dec;13(6):253-259. doi: 10.14740/gr1339. Epub 2020 Dec 23.
Ischemic colitis (IC) occurs when the blood supply of the large intestine becomes compromised. Cirrhosis is a disease entity in which there is a delicate balance between pro-coagulant and anti-coagulant states. Our aim was to examine the impact cirrhosis has on outcomes in patients with ischemic colitis.
A retrospective analysis of patients hospitalized with IC in 2017 was evaluated using the National Inpatient Sample database. Baseline demographic data, length of hospital stay (LOS), total hospital charge, rates of colectomy and in-hospital mortality were extracted from the database. Categorical variables were compared using the Chi-square test and continuous variables were compared using -test.
A total of 29,035 patients with IC were identified, while 420 of these patients also had cirrhosis. Patients with IC and cirrhosis were noted to be younger age at presentation when compared to patients with IC and no cirrhosis (mean 63.9 years vs. 70.4 years; P < 0.001). When comparing both groups, IC patients with cirrhosis were more likely to be male (50% vs. 26.1%; P < 0.001), Black (10.9% vs. 7.6%; P = 0.013) and Hispanic (18% vs. 6.1%; P < 0.001). We found that IC patients with cirrhosis had a longer LOS (7.3 days vs. 4.8 days; P < 0.001), higher total hospital charge ($84,769 vs. $48,347; P < 0.001) and higher mortality rate (10.7% vs. 3.6%; P < 0.001); however, the presence of cirrhosis was not associated with increased odds of undergoing colectomy (odds ratio: 0.31; 95% confidence interval: 0.07 - 1.27; P = 0.104).
The presence of cirrhosis is associated with increased odds of in-hospital mortality in those presenting with IC. This compounds the already high rates of mortality in patients that undergo surgery for IC and could reflect lack of reserve to withstand the ischemic episode in the setting of cirrhosis. Though odds of undergoing colectomy is not increased, patients with cirrhosis warrant closer observation.
当大肠的血液供应受到损害时，就会发生缺血性结肠炎（IC）。肝硬化是一种疾病实体，其中促凝状态和抗凝状态之间存在微妙的平衡。我们的目的是研究肝硬化对缺血性结肠炎患者预后的影响。
使用国家住院样本数据库对2017年因IC住院的患者进行回顾性分析。从数据库中提取基线人口统计学数据、住院时间（LOS）、总住院费用、结肠切除术率和住院死亡率。分类变量使用卡方检验进行比较，连续变量使用t检验进行比较。
共识别出29,035例IC患者，其中420例患者同时患有肝硬化。与无肝硬化的IC患者相比，患有IC和肝硬化的患者在就诊时年龄更小（平均63.9岁对70.4岁；P<0.001）。比较两组时，患有肝硬化的IC患者更可能为男性（50%对26.1%；P<0.001）、黑人（10.9%对7.6%；P = 0.013）和西班牙裔（18%对6.1%；P<0.001）。我们发现，患有肝硬化的IC患者住院时间更长（7.3天对4.8天；P<0.001）、总住院费用更高（84,769美元对48,347美元；P<0.001）且死亡率更高（10.7%对3.6%；P<0.001）；然而，肝硬化的存在与接受结肠切除术的几率增加无关（比值比：0.31；95%置信区间：0.07 - 1.27；P = 0.104）。
肝硬化的存在与IC患者住院死亡率增加的几率相关。这使因IC接受手术的患者本就较高的死亡率更加复杂，并且可能反映出在肝硬化情况下缺乏承受缺血发作的储备能力。尽管接受结肠切除术的几率没有增加，但患有肝硬化的患者需要密切观察。
