Karthik Gnanapandithan, MD, MS1, Olga Aroniadis, MD, MSc2, Lawrence J. Brandt, MD, MACG3, Sohail Mansoor, MD4, Abdul Bhutta, MD5, Michael Silverman, MD6, Marc Fenster, MD7, Paul Feuerstadt, MD8; 1Mayo Clinic, Jacksonville, FL; 2Stony Brook University School of Medicine, Stony Brook, NY; 3Montefiore Medical Center, Bronx, NY; 4Albany Medical Center, Albany, NY; 5State University of New York Upstate Medical Center, Syracuse, NY; 6Cleveland Clinic Foundation, Cleveland, OH; 7Mount Sinai Hospital, New York, NY; 8Yale University, School of Medicine, Hamden, CT
Introduction: The presentation, natural history and prognosis of CI vary based upon severity: mild cases improve with supportive care and severe disease requires urgent surgical evaluation. The ACG guidelines recommended triaging pts into three categories: mild, moderate and severe (Figure 1) based upon factors associated with increased 30-day mortality and colectomy, but this rating schema was created based on expert opinion and limited data. By applying this classification system to an inpatient population with CI, we hypothesize that those with severe disease are at greater risk of poor outcomes. Methods: We conducted a retrospective cohort study of pts with biopsy-proven CI admitted to Yale-New Haven Hospital and Montefiore Medical Center from 2005-2017. Baseline characteristics and outcomes were compared in pts with moderate and severe CI based upon the ACG schema. Multivariate logistic regression was used to predict binary outcomes adjusting for the Charlson Comorbidity Index (CCI). (SAS 9.4) Results: 838 pts met inclusion criteria. 407 and 418 had moderate and severe disease, respectively. Mild CI cases (n=4) were excluded from the analysis. Pts with severe CI were more frequently men (40.1% vs 13.5%, p< 0.0001) and had a higher CCI (5.7 vs 4.4, p< 0.0001). Those with severe CI were more likely to present with unstable hemodynamics (16.5% vs 1.0%, p< 0.0001), peritonitis (17.9% vs 0.0%, p< 0.0001), a higher proportion of small bowel involvement (13.2% vs 0.8%, p< 0.0001), right-sided colon involvement (51.2% vs 3.8%, p< 0.0001) and bowel necrosis (16.2% vs 0.0%, p< 0.0001) compared with moderate CI. Severe CI had higher 30-day mortality (9.6% vs 1.0%, p< 0.0001) and 30-day colectomy (26.1% vs 3.1%, p< 0.0001) rates. When adjusted for CCI, those with severe CI had a greater 30-day mortality (RR 8.7 (3.1-24.5), p< 0.0001), 30-day colectomy (RR 8.3 (4.6-14.8), p< 0.0001), ICU stay (RR 5.7 (3.9-8.3), p< 0.0001), 90-day recurrence (RR 5.3 (2.2-12.7), p=0.0002), 90-day readmission (RR 2.8 (2.0-3.9), p< 0.0001) and length of stay (5.02 days (SE 1.4), p< 0.0001) than those with moderate disease. Discussion: The ACG guideline severity classification of CI as moderate or severe is very effective in isolating those at greatest risk for poor outcomes. Based on this analysis, using this system for inpatients with CI is clinically relevant, and clinicians should consider classification according to these ratings. Further research is needed to guide therapy further according to this rating schema.
Disclosures: Karthik Gnanapandithan indicated no relevant financial relationships. Olga Aroniadis indicated no relevant financial relationships. Lawrence Brandt indicated no relevant financial relationships. Sohail Mansoor indicated no relevant financial relationships. Abdul Bhutta indicated no relevant financial relationships. Michael Silverman indicated no relevant financial relationships. Marc Fenster indicated no relevant financial relationships. Paul Feuerstadt: Merck and Co. – Speaker's Bureau. Rebiotix-Ferring Pharmaceutical – Consultant. Roche Diagnostic – Consultant.