Thongsak Wongpongsalee1,2,3,4, Usah Khrucharoen1,2,3,5, Dennis M Jensen6,7,8,9, Rome Jutabha1,2,3,10, Mary Ellen Jensen1,2,3,5, Gail Thibodeau1,2,3,5. 1. CURE Hemostasis Research Unit and the UCLA Digestive Diseases Research Core Center (UCLA: DDRCC), Los Angeles, CA, USA. 2. David Geffen School of Medicine at University of California, Los Angeles, CA, USA. 3. Vatche and Tamar Manoukian Division of Digestive Diseases and Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA. 4. Division of Trauma Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand. 5. Division of Digestive Diseases and Department of Medicine, Veterans Administration Greater Los Angeles Healthcare System, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA. 6. CURE Hemostasis Research Unit and the UCLA Digestive Diseases Research Core Center (UCLA: DDRCC), Los Angeles, CA, USA. djensen@mednet.ucla.edu. 7. David Geffen School of Medicine at University of California, Los Angeles, CA, USA. djensen@mednet.ucla.edu. 8. Vatche and Tamar Manoukian Division of Digestive Diseases and Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA. djensen@mednet.ucla.edu. 9. Division of Digestive Diseases and Department of Medicine, Veterans Administration Greater Los Angeles Healthcare System, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA. djensen@mednet.ucla.edu. 10. Division of Gastrointestinal and Hepatology and Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
Abstract
PURPOSE: To compare short- and long-term outcomes of hospitalized patients with ischemic colitis (IC) presenting with severe hematochezia and treated medically or colectomy and also those with inpatient vs. outpatient start of hematochezia. METHODS: A retrospective analysis of prospectively collected data for IC patients hospitalized for severe hematochezia from two teaching hospitals was done from 1994 to 2020, with the diagnosis of IC made colonoscopically and confirmed histologically. RESULTS: Ninety-seven patients initially all had medical management for IC. Seventy-two (74.2%) were stable and had no further bleeding; 17 (17.5%) had colon resection; and 8 were critically ill and not surgical candidates. Surgical patients and non-surgical candidate had higher comorbidity scores; received more red blood cell (RBC) transfusion (median (IQR) 5 (3-10) vs. 4.5 (3-6.5) vs. 1 (0-4) units, p < 0.001); had significantly longer hospital and ICU days; had higher severe complication rates (35.3% vs. 100%. vs. 5.6%, p < 0.001); and had higher 30-day all-cause mortality rates (23.5% vs. 87.5% vs. 0, p < 0.001). Inpatients developing IC hemorrhage had more RBC transfusions, more complications, longer hospital stays, and higher mortality than patients whose IC bleeding started as outpatients. CONCLUSIONS: The majority of IC patients hospitalized for severe hematochezia were successfully treated medically. Patients who were not surgical candidate had the highest rates of severe complications and mortality. Surgical patients and those who were not surgical candidate had worse outcomes than the medical group. Patients with inpatient start of bleeding from IC had significantly worse outcomes than those with outpatient start of bleeding.
PURPOSE: To compare short- and long-term outcomes of hospitalized patients with ischemic colitis (IC) presenting with severe hematochezia and treated medically or colectomy and also those with inpatient vs. outpatient start of hematochezia. METHODS: A retrospective analysis of prospectively collected data for IC patients hospitalized for severe hematochezia from two teaching hospitals was done from 1994 to 2020, with the diagnosis of IC made colonoscopically and confirmed histologically. RESULTS: Ninety-seven patients initially all had medical management for IC. Seventy-two (74.2%) were stable and had no further bleeding; 17 (17.5%) had colon resection; and 8 were critically ill and not surgical candidates. Surgical patients and non-surgical candidate had higher comorbidity scores; received more red blood cell (RBC) transfusion (median (IQR) 5 (3-10) vs. 4.5 (3-6.5) vs. 1 (0-4) units, p < 0.001); had significantly longer hospital and ICU days; had higher severe complication rates (35.3% vs. 100%. vs. 5.6%, p < 0.001); and had higher 30-day all-cause mortality rates (23.5% vs. 87.5% vs. 0, p < 0.001). Inpatients developing IC hemorrhage had more RBC transfusions, more complications, longer hospital stays, and higher mortality than patients whose IC bleeding started as outpatients. CONCLUSIONS: The majority of IC patients hospitalized for severe hematochezia were successfully treated medically. Patients who were not surgical candidate had the highest rates of severe complications and mortality. Surgical patients and those who were not surgical candidate had worse outcomes than the medical group. Patients with inpatient start of bleeding from IC had significantly worse outcomes than those with outpatient start of bleeding.
Authors: Siddhant Yadav; Maneesh Dave; Jithinraj Edakkanambeth Varayil; W Scott Harmsen; William J Tremaine; Alan R Zinsmeister; Seth R Sweetser; L Joseph Melton; William J Sandborn; Edward V Loftus Journal: Clin Gastroenterol Hepatol Date: 2014-08-12 Impact factor: 11.382
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