Cirrhosis Is Associated With Worse Outcomes in Ischemic Colitis: A Nationwide Retrospective Study

Eric Then; Caitlin Lund; Dustin J Uhlenhopp; Tagore Sunkara; Vinaya Gaduputi

doi:10.14740/gr1339

Cirrhosis Is Associated With Worse Outcomes in Ischemic Colitis: A Nationwide Retrospective Study

Gastroenterology Res. 2020 Dec;13(6):253-259. doi: 10.14740/gr1339. Epub 2020 Dec 23.

Authors

Eric Then¹, Caitlin Lund², Dustin J Uhlenhopp³, Tagore Sunkara⁴, Vinaya Gaduputi⁴

Affiliations

¹ Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center - Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA.
² Department of General Surgery, MercyOne Des Moines Medical Center, Des Moines, IA, USA.
³ Department of Internal Medicine, MercyOne Des Moines Medical Center, Des Moines, IA, USA.
⁴ Department of Gastroenterology and Hepatology, MercyOne Des Moines Medical Center, Des Moines, IA, USA.

PMID: 33447304
PMCID: PMC7781274
DOI: 10.14740/gr1339

Abstract

Background: Ischemic colitis (IC) occurs when the blood supply of the large intestine becomes compromised. Cirrhosis is a disease entity in which there is a delicate balance between pro-coagulant and anti-coagulant states. Our aim was to examine the impact cirrhosis has on outcomes in patients with ischemic colitis.

Methods: A retrospective analysis of patients hospitalized with IC in 2017 was evaluated using the National Inpatient Sample database. Baseline demographic data, length of hospital stay (LOS), total hospital charge, rates of colectomy and in-hospital mortality were extracted from the database. Categorical variables were compared using the Chi-square test and continuous variables were compared using t-test.

Results: A total of 29,035 patients with IC were identified, while 420 of these patients also had cirrhosis. Patients with IC and cirrhosis were noted to be younger age at presentation when compared to patients with IC and no cirrhosis (mean 63.9 years vs. 70.4 years; P < 0.001). When comparing both groups, IC patients with cirrhosis were more likely to be male (50% vs. 26.1%; P < 0.001), Black (10.9% vs. 7.6%; P = 0.013) and Hispanic (18% vs. 6.1%; P < 0.001). We found that IC patients with cirrhosis had a longer LOS (7.3 days vs. 4.8 days; P < 0.001), higher total hospital charge ($84,769 vs. $48,347; P < 0.001) and higher mortality rate (10.7% vs. 3.6%; P < 0.001); however, the presence of cirrhosis was not associated with increased odds of undergoing colectomy (odds ratio: 0.31; 95% confidence interval: 0.07 - 1.27; P = 0.104).

Conclusions: The presence of cirrhosis is associated with increased odds of in-hospital mortality in those presenting with IC. This compounds the already high rates of mortality in patients that undergo surgery for IC and could reflect lack of reserve to withstand the ischemic episode in the setting of cirrhosis. Though odds of undergoing colectomy is not increased, patients with cirrhosis warrant closer observation.

Keywords: Cirrhosis; Colectomy; Ischemic colitis; Mortality; National Inpatient Sample.