Nonocclusive ischemic colitis: Analysis of risk factors for severity

The purpose of this study was to identify risk factors predictive of severe nonocclussive ischemic colitis (IC) requiring operation or resulting in mortality. One hundred seventeen patients with nonocclussive IC were identified and divided into two groups: those with severe disease (n = 24) and those with disease that resolved with supportive care (n = 93). Univariate and multivariate logistic regression models were used. The splenic flexure was the most common involved segment (57.3%), whereas the right colon was involved in 17.9 per cent of patients. Multivariate logistic regression identified three independent risk factors for severe disease: leukocytosis greater than 15 x 10⁹/L (odds ratio [OR], 5.7; confidence interval [CI], 1.5 to 21), hematocrit less than 35 per cent (OR, 4.5; CI, 1.1 to 17), and history of atrial fibrillation (OR, 15; CI, 1.3 to 190). Right-sided IC and chronic renal insufficiency did not affect severity. Special attention should be given to patients with the following risk factors for a severe course: atrial fibrillation, elevated white blood cell count, and anemia. These factors might enable earlier identification of patients who may benefit from early operation. Further prospective studies focusing on subgroups of IC (occlusive and nonocclusive) are required.