Development and Validation of a Risk Scoring Model for Early Prediction of Severe Colon Ischemia
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ORIGINAL ARTICLE
Development and Validation of a Risk Scoring Model for Early Prediction of Severe Colon Ischemia Min Young Shin1 · Hee Seok Moon1 · In Sun Kwon2 · Jae Ho Park1 · Ju Seok Kim1 · Sun Hyung Kang1 · Eaum Seok Lee1 · Seok Hyun Kim1 · Jae Kyu Sung1 · Byung Seok Lee1 · Hyun Yong Jeong1 Received: 24 December 2019 / Accepted: 10 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Colon ischemia (CI) is injury to the intestines secondary to insufficient blood flow. Its clinical severity can range from mild to life-threatening. Aims To investigate predictive risk factors for CI and propose a scoring model for severe outcomes. Methods We retrospectively analyzed the medical records of patients admitted to Chungnam National University Hospital from January 2010 to December 2018. CI was defined as severe when patients required surgery immediately or after initial conservative management, death occurred after hospitalization, or symptoms persisted after 2 weeks. By controlling for possible confounders from the logistic regression analysis, we obtained a new risk scoring model for the early prediction of severe CI. Furthermore, using the area under the receiver operating characteristics curve (AUROC), we assessed the accuracy of the model. Results A total of 274 patients endoscopically diagnosed with CI were included, of whom 181 had severe CI. In the multivariate analysis, tachycardia, elevated C-reactive protein, Favier endoscopic classification stage ≥ 2, and history of hypertension were independently and significantly associated with severe CI. The AUROC of the model was 0.749. Conclusions This risk scoring model based on the presence of tachycardia, elevated C-reactive protein level, unfavorable endoscopic findings by Favier’s classification, and the history of hypertension could be used to predict severe CI outcomes at an early stage. Keywords Colon ischemia · Prognosis · Risk factors · Predictive model
Introduction Colon ischemia (CI) is the most common vascular disease of the gastrointestinal tract and a common cause of lower gastrointestinal disease [1]. The incidence of CI in the general Western population has been estimated to range from 4.5 to 44 cases per 100,000 persons per year [2], but the exact incidence remains unknown [3]. Most patients with CI present with abdominal pain and diarrhea with hematochezia. * Hee Seok Moon [email protected] 1
Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa‑ro, Jung‑gu, Daejeon 35015, South Korea
Clinical Trials Center, Chungnam National University Hospital, Daejeon, South Korea
2
Neither the symptoms nor laboratory findings are pathognomonic tools for the diagnosis of CI. The key to diagnosis is often a strong clinical suspicion confirmed by computed tomography (CT). A strict definition of CI will require pathologic confirmation by endoscopic biopsy [4, 5]. In a previous study, sev
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