Predictive factors of short-term mortality in ischaemic colitis and development of a new prognostic scoring model of in-hospital mortality.

Background Ischaemic colitis (IC) is the most common form of intestinal ischaemia with a wide spectrum of severity, with possible risk of death. Objective The purpose of this study was to evaluate predictive factors of in-hospital and short-term mortality, in a cohort of patients with IC. Methods Retrospective analysis of IC cases diagnosed between 2008-2013 in a single tertiary centre, with assessment of factors at the time of diagnosis associated with in-hospital and 90-day mortality. Results Of the 203 patients included (132 women), 47 (23%) died during the follow-up (median: 16 months). There were 21 patients (45%) who died during hospitalization and at 90 days there were 30 deaths (64% of total). In multivariate analysis, need for vasopressor support (odds ratio (OR) 11.21; 95% confidence interval (CI): 2.31-54.24; p=0.01), Intermediate or Intensive Care Unit (ICU): admission (OR 7.01; 95% CI: 1.48-33.16; p=0.014) and atrial fibrillation (OR 4.99; 95% CI: 1.1-26.23; p=0.048) were independently and significantly associated with in-hospital mortality. Using the coefficients of the estimated logistic model, we calculated a scoring model to predict the occurrence of in-hospital mortality. The presence of all three risk factors predicted a probability of death of 32% with an area under the receiver operating characteristic curve (AUROC) of 0.89 (95% CI 0.80-0.98. At 90 days, the presence of chronic kidney disease (OR 7.46; 95% CI: 1.87-29.73; p=0.002), and male sex (OR 5.85; 95% CI: 1.57-21.83; p=0.009) were also independently associated with mortality. Conclusions Most deaths in ischaemic colitis occur in the first 90 days after admission, sharing similar risk factors. Assessment of the presence of atrial fibrillation, need of vasopressor support or hospitalization in the intermediate/intensive care unit provides a useful tool to estimate in-hospital mortality and to establish the management for patients admitted for ischaemic colitis.