The Risk Factors And Clinical Features For Different Degree Of Ischemic Colitis

Background:Ischemic colitis is an ischemic disease of the colon caused by atery insufficiency or blocked venous return,Improving the early diagnosis and treatment of severe ischemic colitis is critical for the prognosis.Objective:In order to improve clinicians' understanding and reduce the misdiagnosis of ischemic colitis,the clinical characteristics of ischemic colitis in different degree was retrospectively analyzed to explore the possible risk factors of severe IC.Methods:Collect the data of 144 patients diagnosed IC in the second hospital of dalian medical university from October 2006 to September 2018.According to the treatment methods and prognosis,144 patients were divided into two groups: 127 cases in the mild group and 17 cases in the severe group.The gender,age,combined with basic diseases,smoking history,drinking history,abdominal surgery history,tmedication history,clinical manifestations,abdominal signs,laboratory results,abdominal CT and CTA,endoscopic performance were compared between the mild group and the severe group,to explore the possible risk factors of severe IC by univariate and multivariate analysis.Results:1.The general data of 144 patients with IC:(1)Gender:There were 52 men(36.1%)and 92 women(63.9%).The ratio of male to female was 1:1.769,most patients are females.(2)Age: The minimum and the Maximum onset age was 29 years old and 87 years old respectively.The average onset age was 64.03 ±12.58 years old,and the peak age between 50 to 70 years old,accounting for 59.4%.(3)Comorbidities:There are 67 cases with hypertension(46.5%),31 cases with diabetes(21.5%),17 cases with coronary heart disease(11.8%).(4)Smoking and drinking history: There are 19 smoking patients(13.2%),and 8 drinking patients(5.6%).(5)Abdominal surgery history :there are 46 cases with abdominal surgery(32.0%);52 cases taking antihypertensive drugs(36.1%);19 cases taking hypoglycemic drugs(13.3%);6 patients cases takinganticoagulant drugs(4.2%).2.Clinical manifestations:(1)Initial clinical manifestations:130 cases with abdominal pain(89.6%),124 cases with hematochezia(86.1%),90 cases with diarrhea(62.5%),62 cases with nausea and vomiting(43.0%),19 cases with abdominal distension(12.3%),10 cases with fever(6.9%),abdominal pain,hematochezia and diarrhea is predominant.(2)Characteristics of abdominal pain: 58 cases with lower abdominal pain(40.3%);23 cases with left lower abdominal pain(16%),lower abdominal pain and left lower abdominal pain are predominant.(3)Hematochezia characteristics: 81 cases with fresh blood stool(56.3%),37 cases with dark red colored bloody stool(25.7%),fresh blood stool is predominant.(4)Abdominal signs :108 cases with abdominal tenderness without rebound pain and muscle tension(75%);15 cases with peritoneal irritation(10.4%);21 cases had no abdominal signs(14.6%).3.Laboratory results of 144 patients with IC:94 cases were with an increase in white blood cell count or neutrophil percentage ratio,accounting for 65.3%,17 cases with anemia,accounting for 11.9%,19 cases with thrombocytopenia,accounting for 13.3%,78 cases were with hypoalbuminemia,accounting for 54.6%,12 cases were with an elevated BUN,accounting for 8.4%,53 cases were with an elevated D-dimer,accounting for 37.1%.4.Endoscopic manifestations:(1)endoscopic typing: 113 cases belonged to transient types,accounting for 78.5%;16 cases with stricture type accounting for 11.1%;15 cases belonged to gangrenous type accounting for 10.4%;transient type is predominant;(2)The lesion range of the disease: 90 cases with left colon involved,accounting for 62.5%;17 cases with right colon,accounting for 11.8%;30 with whole colon,accounting for20.8%,7cases with transverse colon,accounting for 4.9%,left colon is predominant,accounting for 62.5%.5.Abdominal CT,CTA: the positive rate of CT was 47.4%,and the positive rate of CTA was 34.3%.6.Comparison between the mild group and the severe group:(1)old age predisposes to severe IC(P=0.003).(2)Patients with diabetes(P=0.006),coronary heart disease(P=0.032),atrial fibrillation(P=0.000),and stroke(P=0.037)are prone to severe IC.(3)taking antihypertensive drugs is prone to severe IC(P=0.038).(4)Patients without hematochezia(P=0.000),with nausea and vomiting(P=0.014),abdominal distension(P=0.012),peritoneal stimulation(P=0.001),are easierto develop severe IC.Patients with hematochezia was prone to occur in mild IC(P=0.000).(5)Patients with gangrene type(P=0.000)and lesion site of right colon(P=0.000)are prone to severe IC.(6)Patients with abdominal CTA positive are prone to severe IC(P=0.006).(7)The higher white blood cell value(P=0.000),neutrophil percentage ratio(P=0.000),blood urea nitrogen(P=0.000),d-dimer(P=0.000)were prone to severe IC.7.The risk factors related to severe ischemic colitis:Single-factor analysis:(1)age,diabetes,coronary heart disease,atrial fibrillation,stroke,antihypertensive drugs taking history,right colon involved,higher white blood cell value,neutrophil percentage ratio,blood urea nitrogen,d-dimer,abdominal CTA positive,are risks factor associated with severe IC(P<0.05).(2)Multivariate analysis:higher neutrophil percentage ratio and abdominal CTA positive are independent risk factors for severe IC.Conclusions:Ischemic colitis is more common in women.The patients are mainly aged people,and the main clinical manifestations were nausea,vomiting and abdominal distension,gangrene type and the right colon is the most vulnerable site.Diabetes,coronary heart disease,atrial fibrillation,stroke,higher neutrophil percentage ratio and the abdominal CTA positive are risk factors for severe IC,and the latter two are independent risk factors.To improve the early diagnosis,treatment and prognosis of severe IC,clinicians should pay attention to the above risk factors and analyze the clinical characteristics.