Milluzzo Sebastian Manuel, Correale Loredana, Marco Guido De, Antonelli Giulio, Cesaro Paola, Olivari Nicola, Terragnoli Paolo, Sabatini Tony, Hassan Cesare, Spada Cristiano
Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (Sebastian Manuel Milluzzo, Paola Cesaro, Nicola Olivari, Tony Sabatini, Cristiano Spada).
Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS -Università Cattolica del Sacro Cuore, Rome (Sebastian Manuel Milluzzo, Cristiano Spada).
Ann Gastroenterol. 2021;34(2):202-207. doi: 10.20524/aog.2021.0577. Epub 2021 Jan 16.
Ischemic colitis (IC) is caused by a transient hypo-perfusion of the colon leading to mucosal ulcerations, inflammation, and hemorrhage. The primary aim was to identify predictive factors of endoscopic severity of IC. Secondary endpoints were to show epidemiology, clinical presentation, endoscopic findings, and outcomes of IC.
In this single-center retrospective analysis, IC was scored according to endoscopy as: grade 1 (hyperemia, <1 cm erosions and non-confluent ulcers); grade 2 (>1 cm superficial, partially confluent ulcers); and grade 3 (deep or diffuse ulcers or necrosis). Then, IC was grouped into low- (grade 1) and high-grade (grades 2 and 3). Significant (P≤0.1) independent factor of severe IC at univariate analysis were entered into multivariate analysis and considered significant at P<0.05.
227 patients (male:female 60:167; mean age 72.7±16.2 years) were included. IC was scored as grade 1 in 137/227 (60.4%), grade 2 in 62/227 (27.3%), and grade 3 in 28/227 (12.3%) patients. At univariate analysis, age (74.9 vs. 71.3 years; P=0.09), diabetes (14.4% vs. 12.4%; P=0.09), and leukocytosis or creatinine elevation (74.4% vs. 60.6%; P=0.032) were associated with endoscopic high-grade IC. At multivariate analysis, leukocytosis and creatinine levels remained associated with high-grade IC (44.7% vs. 29.9%; odds ratio 1.92, 95% confidence interval 1.07-3.52; P=0.030).
Although confounding factors cannot be excluded due to study design and patients' characteristics, leukocytosis and/or creatinine elevation at hospital admission were significantly related with endoscopic high-grade IC and might be used to stratify patients for the need of endoscopy.
缺血性结肠炎（IC）是由结肠短暂性低灌注导致黏膜溃疡、炎症和出血引起的。主要目的是确定IC内镜严重程度的预测因素。次要终点是展示IC的流行病学、临床表现、内镜检查结果及预后。
在这项单中心回顾性分析中，IC根据内镜检查分为：1级（充血、<1 cm糜烂及非融合性溃疡）；2级（>1 cm浅表、部分融合性溃疡）；3级（深部或弥漫性溃疡或坏死）。然后，IC被分为低级别（1级）和高级别（2级和3级）。单因素分析中与严重IC显著相关（P≤0.1）的独立因素纳入多因素分析，P<0.05时被视为具有显著性。
纳入227例患者（男:女为60:167；平均年龄72.7±16.2岁）。137/227（60.4%）例患者IC评分为1级，62/227（27.3%）例为2级，28/227（12.3%）例为3级。单因素分析中，年龄（74.9岁对71.3岁；P=0.09）、糖尿病（14.4%对12.4%；P=0.09）以及白细胞增多或肌酐升高（74.4%对60.6%；P=0.032）与内镜高级别IC相关。多因素分析中，白细胞增多和肌酐水平仍与高级别IC相关（44.7%对29.9%；比值比1.92，95%置信区间1.07 - 3.52；P=0.030）。
尽管由于研究设计和患者特征无法排除混杂因素，但入院时白细胞增多和/或肌酐升高与内镜高级别IC显著相关，可用于对患者进行内镜检查需求分层。
