Zapalenie niedokrwienne jelita grubego
Rokowania, prognozy i postęp choroby

Zapalenie niedokrwienne jelita grubego (ZNJG) cechuje się szerokim spektrum klinicznym, od łagodnych, samoograniczających się postaci do ciężkich, wymagających pilnej interwencji chirurgicznej. Śmiertelność wewnątrzszpitalna wynosi około 10%, natomiast 5-letnia śmiertelność sięga 31%, głównie z powodu chorób współistniejących. Po pilnej kolektomii śmiertelność 90-dniowa może osiągać 70,2%. Łagodny przebieg obserwuje się u około 75% pacjentów, z ograniczonym niedokrwieniem błony śluzowej i dobrym rokowaniem. Kluczowe czynniki prognostyczne ciężkiego przebiegu to objawy otrzewnowe, tachykardia, anemia, hiponatremia, zwężenie jelita w endoskopii, przewlekła choroba nerek, wysoki wynik ECOG, podwyższone mleczany przedoperacyjne, opóźnienie interwencji chirurgicznej >12 godzin oraz pooperacyjne ostre uszkodzenie nerek. Etiologia ZNJG nie wpływa istotnie na rokowanie pooperacyjne.

  1. Prognoza zapalenia niedokrwiennego jelita grubego
    1. Wskaźniki śmiertelności
    2. Czynniki prognostyczne łagodnego przebiegu
    3. Czynniki prognostyczne ciężkiego przebiegu
    4. Klasyfikacja ischemi na podstawie obrazu histopatologicznego
    5. Skale prognostyczne
    6. Ryzyko nawrotu
    7. Znaczenie wczesnej interwencji
    8. Specyficzne grupy pacjentów
  2. Podsumowanie rokowania w ZNJG
    1. Kolejne rozdziały

Prognoza zapalenia niedokrwiennego jelita grubego

Zapalenie niedokrwienne jelita grubego (ZNJG) charakteryzuje się szerokim spektrum klinicznym – od łagodnych, samoograniczających się przypadków, po ciężkie postacie wymagające pilnej interwencji chirurgicznej. Rokowanie pacjentów z ZNJG jest zróżnicowane i zależy od wielu czynników, których wczesna identyfikacja ma kluczowe znaczenie dla wyboru optymalnej strategii terapeutycznej.12

Wskaźniki śmiertelności

Współczynniki śmiertelności w ZNJG pozostają stosunkowo wysokie, co potwierdzają dane z różnych badań naukowych. Śmiertelność wewnątrzszpitalna wynosi około 10%, jednak dotyczy głównie pacjentów z ciężką postacią choroby.3 W obserwacji długoterminowej, śmiertelność w ciągu 5 lat sięga nawet 31%, przy czym warto zaznaczyć, że większość zgonów (28 z 30 w jednym z badań) nie jest bezpośrednio związana z zapaleniem niedokrwiennym, lecz wynika z chorób współistniejących.4

W przypadku pacjentów wymagających pilnego zabiegu kolektomii z powodu ZNJG, śmiertelność pooperacyjna w ciągu 90 dni może osiągać alarmujący poziom 70,2%, co podkreśla wagę wczesnej diagnostyki i interwencji.5

Czynniki prognostyczne łagodnego przebiegu

Około 75% pacjentów z ostrym ZNJG doświadcza stosunkowo łagodnej i przemijającej postaci choroby, która obejmuje tylko warstwę śluzówki w jednym segmencie jelita. Pacjenci ci zwykle całkowicie wracają do zdrowia po leczeniu zachowawczym.6 Analiza regresji logistycznej wykazała, że obecność krwistych stolców (hematochezja) może być słabym, ale istotnym predyktorem łagodnego przebiegu ZNJG.7

Czynniki prognostyczne ciężkiego przebiegu

Identyfikacja czynników ryzyka ciężkiego przebiegu ZNJG ma kluczowe znaczenie dla wdrożenia odpowiedniego postępowania terapeutycznego. Do najważniejszych czynników prognostycznych należą:

Co istotne, etiologia ZNJG (np. powikłania po operacjach aorty czy inne przyczyny) nie wydaje się mieć istotnego wpływu na rokowanie pooperacyjne.18

Klasyfikacja ischemi na podstawie obrazu histopatologicznego

Śmiertelność w ZNJG jest ściśle powiązana ze stopniem uszkodzenia niedokrwiennego ściany jelita, co zostało ujęte w klasyfikacji Faviersa:

  • Stadium I: niedokrwienie ograniczone do błony śluzowej – śmiertelność 0%19
  • Stadium II: niedokrwienie rozszerzone na warstwę mięśniową błony śluzowej z dużymi owrzodzeniami20
  • Stadium III: niedokrwienie pełnościenne (transmuralne) z martwicą warstwy mięśniowej i możliwą perforacją – śmiertelność 75%21

Skale prognostyczne

W literaturze opisano różne skale prognostyczne, które mogą pomóc w ocenie rokowania pacjentów z ZNJG. Jedną z nich jest skala PALM, oparta na oznaczeniach prokalcytoniny, AspAT, mleczanów i mioglobiny, która wykazuje wysoką skuteczność w diagnozowaniu niedokrwienia jelit po operacjach kardiochirurgicznych. Wczesne zastosowanie tej skali może przyczynić się do szybszej diagnostyki i wdrożenia odpowiedniego leczenia, co potencjalnie zmniejsza śmiertelność w tej grupie pacjentów.22

Ryzyko nawrotu

Ryzyko nawrotu ZNJG jest stosunkowo niskie i wzrasta z czasem obserwacji. Szacunkowe wskaźniki nawrotów wynoszą 2,9%, 5,1%, 8,1% i 9,7% odpowiednio po 1, 2, 3 i 5 latach od pierwszego epizodu.23 Wiek jest jedynym czynnikiem, który wykazuje istotny związek ze zwiększoną śmiertelnością w długoterminowej obserwacji (średni wiek pacjentów zmarłych: 78,6 lat vs. 72,5 lat u pacjentów, którzy przeżyli).24

Znaczenie wczesnej interwencji

Diagnostyka i leczenie ZNJG stanowią wyzwanie ze względu na brak specyficznych objawów klinicznych i markerów biologicznych, co może prowadzić do opóźnienia w postawieniu diagnozy i wdrożeniu odpowiedniego leczenia.25 Wczesna interwencja jest szczególnie istotna u pacjentów z czynnikami ryzyka ciężkiego przebiegu, takimi jak przewlekła choroba nerek czy zły stan ogólny. U tych pacjentów należy rozważyć wczesne, aktywne leczenie, w tym interwencję chirurgiczną, oraz prowadzić ścisłą obserwację kliniczną.26

Specyficzne grupy pacjentów

Pacjenci z chorobami współistniejącymi, takimi jak choroby serca czy nerek, stanowią grupę szczególnego ryzyka niepomyślnego przebiegu ZNJG. W tej populacji ryzyko powikłań i zgonu (około 40%) jest statystycznie wyższe, choć należy podkreślić, że nie wynika ono wyłącznie z zapalenia niedokrwiennego jelita grubego.27

W przypadku ZNJG występującego jako powikłanie po operacjach kardiochirurgicznych, śmiertelność jest szczególnie wysoka – w jednym z badań sięgała 81,3% w grupie z niedokrwieniem jelit w porównaniu do 7,3% w grupie bez tego powikłania.28

Podsumowanie rokowania w ZNJG

Zapalenie niedokrwienne jelita grubego pozostaje chorobą o zróżnicowanym rokowaniu, zależnym od wielu czynników klinicznych, laboratoryjnych i endoskopowych. Identyfikacja pacjentów wysokiego ryzyka niepomyślnego przebiegu choroby ma kluczowe znaczenie dla optymalizacji postępowania terapeutycznego. Brak krwistych stolców, obecność tachykardii, objawów otrzewnowych, niedokrwistości, hiponatremii, przewlekłej choroby nerek oraz zły stan ogólny pacjenta według skali ECOG są najważniejszymi czynnikami złego rokowania.2930

Mimo postępów w diagnostyce i leczeniu, śmiertelność w ZNJG pozostaje stosunkowo wysoka, szczególnie w przypadku pacjentów wymagających interwencji chirurgicznej. Natomiast ryzyko nawrotu choroby jest relatywnie niskie i wynosi około 10% w ciągu 5 lat obserwacji.31

Kolejne rozdziały

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  1. 13.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Factors predicting poor prognosis in ischemic colitis
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4087624/
    AIM: To determine the clinical, analytical and endoscopic factors related to ischemic colitis (IC) severity. […] CONCLUSION: The factors that can predict poor prognosis of IC are the absence of hematochezia, tachycardia and peritonism, anemia and hyponatremia and stenosis. […] Evolution of IC in patients depends on the severity of the presentation. Most mildly affected patients are asymptomatic after medical treatment. Severely affected patients and those that have strictures need to undergo surgery and have a higher morbidity and mortality rate. […] The possibility of establishing prognostic factors promptly is of great importance in deciding the best therapeutic strategy for each case. […] Logistic regression analysis showed that hematochezia was a weak predictor of mild IC, while signs of peritonism, tachycardia, anemia and hyponatremia were associated with severe IC.
  • #2 Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period
    https://www.wjgnet.com/1007-9327/full/v19/i44/8042.htm
    Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period. […] The prognosis of patients with ischemic colitis is unknown. In this study we observed that recurrence rate of ischemic colitis was low (9.7% at 5 years). However, the mortality was high (31% at 5 years) and the only factor associated with mortality was age. […] Estimated IC recurrence rates were 2.9%, 5.1%, 8.1% and 9.7% at years 1, 2, 3 and 5 years, respectively. Five-year survival was 69% (93 of 135) and 24% (10 of 42 patients) died for causes related to the IC. […] The five-year recurrence rate of IC was low. On the other hand, mortality during follow-up was high and was not associated with ischemic colitis. […] Considering the course of the 123 patients, 30 (24.3%) of them died within 5 years, 28 due to comorbidities and only 2 due to recurrence and complications of the IC. The only factor that was associated increased mortality was age (72.5 11 years vs 78.6 years; P0.001). […] The mortality rate of IC is still high and the recurrence increases with time. In our study, mortality due to IC at the first admission was 5.9% and 7.4% five years later. The overall rates of mortality, including comorbidities were 8.8% and 31.1% respectively.
  • #3 Factors predicting poor prognosis in ischemic colitis
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4087624/
    The mortality of our patients was almost 10% and all the patients suffered from severe IC, differing greatly from that reported in the literature. […] In conclusion, ischemic colitis is an illness that should be considered in any elderly patients with clinical and therapeutic risk factors, such as abdominal pain and/or hematochezia. The mortality rate of ischemic colitis is still high.
  • #4 Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period
    https://www.wjgnet.com/1007-9327/full/v19/i44/8042.htm
    Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period. […] The prognosis of patients with ischemic colitis is unknown. In this study we observed that recurrence rate of ischemic colitis was low (9.7% at 5 years). However, the mortality was high (31% at 5 years) and the only factor associated with mortality was age. […] Estimated IC recurrence rates were 2.9%, 5.1%, 8.1% and 9.7% at years 1, 2, 3 and 5 years, respectively. Five-year survival was 69% (93 of 135) and 24% (10 of 42 patients) died for causes related to the IC. […] The five-year recurrence rate of IC was low. On the other hand, mortality during follow-up was high and was not associated with ischemic colitis. […] Considering the course of the 123 patients, 30 (24.3%) of them died within 5 years, 28 due to comorbidities and only 2 due to recurrence and complications of the IC. The only factor that was associated increased mortality was age (72.5 11 years vs 78.6 years; P0.001). […] The mortality rate of IC is still high and the recurrence increases with time. In our study, mortality due to IC at the first admission was 5.9% and 7.4% five years later. The overall rates of mortality, including comorbidities were 8.8% and 31.1% respectively.
  • #5 Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00321-4
    Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. […] Overall, 66 patients (70.2%) died within 90 days from surgery. […] Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality. […] The present single-center study showed that IC requiring an emergency open colectomy is associated with a high postoperative mortality, which can be predicted by high levels of preoperative lactates, delayed interval from signs/symptoms onset to surgery ( 12h), and the occurrence of postoperative acute kidney injury. On the contrary, the specific etiology of IC does not impact on the outcome. […] The specific etiology of IC, namely aortic surgery complications or other causes, appears to have no impact on postoperative mortality.
  • #6 Ischemic Colitis: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/24513-ischemic-colitis
    Most people with acute ischemic colitis (75%) have a relatively mild and transient case that affects only the mucous lining in one segment. Most will recover fully with conservative treatment. […] A smaller percentage of people have a more complicated case that requires surgery. Those who have complications tend to be those with preexisting conditions, such as heart disease and kidney disease, which make surgery riskier and recovery more difficult. This group is statistically more at risk of unfavorable outcomes and death (about 40%), although the risk isn’t from ischemic colitis alone.
  • #7 Factors predicting poor prognosis in ischemic colitis
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4087624/
    AIM: To determine the clinical, analytical and endoscopic factors related to ischemic colitis (IC) severity. […] CONCLUSION: The factors that can predict poor prognosis of IC are the absence of hematochezia, tachycardia and peritonism, anemia and hyponatremia and stenosis. […] Evolution of IC in patients depends on the severity of the presentation. Most mildly affected patients are asymptomatic after medical treatment. Severely affected patients and those that have strictures need to undergo surgery and have a higher morbidity and mortality rate. […] The possibility of establishing prognostic factors promptly is of great importance in deciding the best therapeutic strategy for each case. […] Logistic regression analysis showed that hematochezia was a weak predictor of mild IC, while signs of peritonism, tachycardia, anemia and hyponatremia were associated with severe IC.
  • #8 Factors predicting poor prognosis in ischemic colitis
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4087624/
    AIM: To determine the clinical, analytical and endoscopic factors related to ischemic colitis (IC) severity. […] CONCLUSION: The factors that can predict poor prognosis of IC are the absence of hematochezia, tachycardia and peritonism, anemia and hyponatremia and stenosis. […] Evolution of IC in patients depends on the severity of the presentation. Most mildly affected patients are asymptomatic after medical treatment. Severely affected patients and those that have strictures need to undergo surgery and have a higher morbidity and mortality rate. […] The possibility of establishing prognostic factors promptly is of great importance in deciding the best therapeutic strategy for each case. […] Logistic regression analysis showed that hematochezia was a weak predictor of mild IC, while signs of peritonism, tachycardia, anemia and hyponatremia were associated with severe IC.
  • #9 Factors predicting poor prognosis in ischemic colitis
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4087624/
    AIM: To determine the clinical, analytical and endoscopic factors related to ischemic colitis (IC) severity. […] CONCLUSION: The factors that can predict poor prognosis of IC are the absence of hematochezia, tachycardia and peritonism, anemia and hyponatremia and stenosis. […] Evolution of IC in patients depends on the severity of the presentation. Most mildly affected patients are asymptomatic after medical treatment. Severely affected patients and those that have strictures need to undergo surgery and have a higher morbidity and mortality rate. […] The possibility of establishing prognostic factors promptly is of great importance in deciding the best therapeutic strategy for each case. […] Logistic regression analysis showed that hematochezia was a weak predictor of mild IC, while signs of peritonism, tachycardia, anemia and hyponatremia were associated with severe IC.
  • #10 Factors predicting poor prognosis in ischemic colitis
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4087624/
    AIM: To determine the clinical, analytical and endoscopic factors related to ischemic colitis (IC) severity. […] CONCLUSION: The factors that can predict poor prognosis of IC are the absence of hematochezia, tachycardia and peritonism, anemia and hyponatremia and stenosis. […] Evolution of IC in patients depends on the severity of the presentation. Most mildly affected patients are asymptomatic after medical treatment. Severely affected patients and those that have strictures need to undergo surgery and have a higher morbidity and mortality rate. […] The possibility of establishing prognostic factors promptly is of great importance in deciding the best therapeutic strategy for each case. […] Logistic regression analysis showed that hematochezia was a weak predictor of mild IC, while signs of peritonism, tachycardia, anemia and hyponatremia were associated with severe IC.
  • #11 Factors predicting poor prognosis in ischemic colitis
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4087624/
    AIM: To determine the clinical, analytical and endoscopic factors related to ischemic colitis (IC) severity. […] CONCLUSION: The factors that can predict poor prognosis of IC are the absence of hematochezia, tachycardia and peritonism, anemia and hyponatremia and stenosis. […] Evolution of IC in patients depends on the severity of the presentation. Most mildly affected patients are asymptomatic after medical treatment. Severely affected patients and those that have strictures need to undergo surgery and have a higher morbidity and mortality rate. […] The possibility of establishing prognostic factors promptly is of great importance in deciding the best therapeutic strategy for each case. […] Logistic regression analysis showed that hematochezia was a weak predictor of mild IC, while signs of peritonism, tachycardia, anemia and hyponatremia were associated with severe IC.
  • #12 Factors predicting poor prognosis in ischemic colitis
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4087624/
    AIM: To determine the clinical, analytical and endoscopic factors related to ischemic colitis (IC) severity. […] CONCLUSION: The factors that can predict poor prognosis of IC are the absence of hematochezia, tachycardia and peritonism, anemia and hyponatremia and stenosis. […] Evolution of IC in patients depends on the severity of the presentation. Most mildly affected patients are asymptomatic after medical treatment. Severely affected patients and those that have strictures need to undergo surgery and have a higher morbidity and mortality rate. […] The possibility of establishing prognostic factors promptly is of great importance in deciding the best therapeutic strategy for each case. […] Logistic regression analysis showed that hematochezia was a weak predictor of mild IC, while signs of peritonism, tachycardia, anemia and hyponatremia were associated with severe IC.
  • #13 Predictive Factors for Severe Outcomes in Ischemic Colitis
    https://www.gutnliver.org/journal/view.html?pn=search&uid=744&vmd=Full
    Ischemic colitis includes a wide clinical spectrum ranging from mild to severe forms. This study aimed to determine the factors that are related to the occurrence of severe ischemic colitis. […] In the comparison of comorbidities, the severe group had a higher ratio of chronic kidney disease than the mild group (p=0.001). […] A multivariate analysis showed that chronic kidney disease and high ECOG performance status scores were significant risk factors. […] If patients diagnosed with ischemic colitis are also treated for chronic kidney disease or have poor performance status, more attention and early intervention are necessary. […] The ECOG performance status score has been known to be closely related to the prognosis of patients with cancer in general. […] In conclusion, factors that can predict poor prognosis in ischemic colitis were comorbidity of chronic kidney disease and high ECOG performance status score. Therefore, it is necessary for patients with suspicious ischemic colitis to receive active treatment (e.g., surgery) at an early stage and to be observed carefully if they are treated with chronic kidney disease and if their performance status is poor overall.
  • #14 Predictive Factors for Severe Outcomes in Ischemic Colitis
    https://www.gutnliver.org/journal/view.html?pn=search&uid=744&vmd=Full
    Ischemic colitis includes a wide clinical spectrum ranging from mild to severe forms. This study aimed to determine the factors that are related to the occurrence of severe ischemic colitis. […] In the comparison of comorbidities, the severe group had a higher ratio of chronic kidney disease than the mild group (p=0.001). […] A multivariate analysis showed that chronic kidney disease and high ECOG performance status scores were significant risk factors. […] If patients diagnosed with ischemic colitis are also treated for chronic kidney disease or have poor performance status, more attention and early intervention are necessary. […] The ECOG performance status score has been known to be closely related to the prognosis of patients with cancer in general. […] In conclusion, factors that can predict poor prognosis in ischemic colitis were comorbidity of chronic kidney disease and high ECOG performance status score. Therefore, it is necessary for patients with suspicious ischemic colitis to receive active treatment (e.g., surgery) at an early stage and to be observed carefully if they are treated with chronic kidney disease and if their performance status is poor overall.
  • #15 Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00321-4
    Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. […] Overall, 66 patients (70.2%) died within 90 days from surgery. […] Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality. […] The present single-center study showed that IC requiring an emergency open colectomy is associated with a high postoperative mortality, which can be predicted by high levels of preoperative lactates, delayed interval from signs/symptoms onset to surgery ( 12h), and the occurrence of postoperative acute kidney injury. On the contrary, the specific etiology of IC does not impact on the outcome. […] The specific etiology of IC, namely aortic surgery complications or other causes, appears to have no impact on postoperative mortality.
  • #16 Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00321-4
    Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. […] Overall, 66 patients (70.2%) died within 90 days from surgery. […] Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality. […] The present single-center study showed that IC requiring an emergency open colectomy is associated with a high postoperative mortality, which can be predicted by high levels of preoperative lactates, delayed interval from signs/symptoms onset to surgery ( 12h), and the occurrence of postoperative acute kidney injury. On the contrary, the specific etiology of IC does not impact on the outcome. […] The specific etiology of IC, namely aortic surgery complications or other causes, appears to have no impact on postoperative mortality.
  • #17 Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00321-4
    Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. […] Overall, 66 patients (70.2%) died within 90 days from surgery. […] Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality. […] The present single-center study showed that IC requiring an emergency open colectomy is associated with a high postoperative mortality, which can be predicted by high levels of preoperative lactates, delayed interval from signs/symptoms onset to surgery ( 12h), and the occurrence of postoperative acute kidney injury. On the contrary, the specific etiology of IC does not impact on the outcome. […] The specific etiology of IC, namely aortic surgery complications or other causes, appears to have no impact on postoperative mortality.
  • #18 Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00321-4
    Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. […] Overall, 66 patients (70.2%) died within 90 days from surgery. […] Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality. […] The present single-center study showed that IC requiring an emergency open colectomy is associated with a high postoperative mortality, which can be predicted by high levels of preoperative lactates, delayed interval from signs/symptoms onset to surgery ( 12h), and the occurrence of postoperative acute kidney injury. On the contrary, the specific etiology of IC does not impact on the outcome. […] The specific etiology of IC, namely aortic surgery complications or other causes, appears to have no impact on postoperative mortality.
  • #19 Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score | Annals of Intensive Care | Full Text
    https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0395-5
    Bowel ischemia is a life-threatening emergency defined as an inadequate vascular perfusion leading to bowel inflammation resulting from impaired colonic/small bowel blood supply. […] The associated mortality reported in the literature is more than 75% for mesenteric ischemia and depends on the mucosal ischemic damage stage of the colon (Faviers classification): Stage I is an ischemia limited to the mucosa (0% mortality), stage II is an ischemia extended to the muscularis mucosa with large ulcerations, and stage III is a transmural ischemia with necrosis of the muscularis and possible perforation (mortality 75%). […] The main issue for physicians about bowel ischemia diagnosis lies in the absence of informative and specific clinical or biological signs leading to delayed management and resulting in a poorer prognosis, especially after cardiac surgery.
  • #20 Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score | Annals of Intensive Care | Full Text
    https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0395-5
    Bowel ischemia is a life-threatening emergency defined as an inadequate vascular perfusion leading to bowel inflammation resulting from impaired colonic/small bowel blood supply. […] The associated mortality reported in the literature is more than 75% for mesenteric ischemia and depends on the mucosal ischemic damage stage of the colon (Faviers classification): Stage I is an ischemia limited to the mucosa (0% mortality), stage II is an ischemia extended to the muscularis mucosa with large ulcerations, and stage III is a transmural ischemia with necrosis of the muscularis and possible perforation (mortality 75%). […] The main issue for physicians about bowel ischemia diagnosis lies in the absence of informative and specific clinical or biological signs leading to delayed management and resulting in a poorer prognosis, especially after cardiac surgery.
  • #21 Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score | Annals of Intensive Care | Full Text
    https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0395-5
    Bowel ischemia is a life-threatening emergency defined as an inadequate vascular perfusion leading to bowel inflammation resulting from impaired colonic/small bowel blood supply. […] The associated mortality reported in the literature is more than 75% for mesenteric ischemia and depends on the mucosal ischemic damage stage of the colon (Faviers classification): Stage I is an ischemia limited to the mucosa (0% mortality), stage II is an ischemia extended to the muscularis mucosa with large ulcerations, and stage III is a transmural ischemia with necrosis of the muscularis and possible perforation (mortality 75%). […] The main issue for physicians about bowel ischemia diagnosis lies in the absence of informative and specific clinical or biological signs leading to delayed management and resulting in a poorer prognosis, especially after cardiac surgery.
  • #22 Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score | Annals of Intensive Care | Full Text
    https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0395-5
    In the ischemia group, the postoperative mortality rate was 81.3% (n=39) vs. 7.3% (n=7) in the non-ischemia group. […] The clinical interest of this score for the diagnosis of bowel ischemia may be attributed to its impact on the management of patients, especially those with a high risk of bowel ischemia after cardiovascular surgery; earlier CT scan and colonoscopies with a concomitant decrease in mortality due to a more aggressive management. […] A biological scoring system based on PCT, ASAT, lactate, and myoglobin allows the diagnosis of bowel ischemia after cardiac surgery with high accuracy. This score could help clinician to propose an early diagnosis and to propose an early treatment in this high mortality disease.
  • #23 Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period
    https://www.wjgnet.com/1007-9327/full/v19/i44/8042.htm
    Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period. […] The prognosis of patients with ischemic colitis is unknown. In this study we observed that recurrence rate of ischemic colitis was low (9.7% at 5 years). However, the mortality was high (31% at 5 years) and the only factor associated with mortality was age. […] Estimated IC recurrence rates were 2.9%, 5.1%, 8.1% and 9.7% at years 1, 2, 3 and 5 years, respectively. Five-year survival was 69% (93 of 135) and 24% (10 of 42 patients) died for causes related to the IC. […] The five-year recurrence rate of IC was low. On the other hand, mortality during follow-up was high and was not associated with ischemic colitis. […] Considering the course of the 123 patients, 30 (24.3%) of them died within 5 years, 28 due to comorbidities and only 2 due to recurrence and complications of the IC. The only factor that was associated increased mortality was age (72.5 11 years vs 78.6 years; P0.001). […] The mortality rate of IC is still high and the recurrence increases with time. In our study, mortality due to IC at the first admission was 5.9% and 7.4% five years later. The overall rates of mortality, including comorbidities were 8.8% and 31.1% respectively.
  • #24 Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period
    https://www.wjgnet.com/1007-9327/full/v19/i44/8042.htm
    Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period. […] The prognosis of patients with ischemic colitis is unknown. In this study we observed that recurrence rate of ischemic colitis was low (9.7% at 5 years). However, the mortality was high (31% at 5 years) and the only factor associated with mortality was age. […] Estimated IC recurrence rates were 2.9%, 5.1%, 8.1% and 9.7% at years 1, 2, 3 and 5 years, respectively. Five-year survival was 69% (93 of 135) and 24% (10 of 42 patients) died for causes related to the IC. […] The five-year recurrence rate of IC was low. On the other hand, mortality during follow-up was high and was not associated with ischemic colitis. […] Considering the course of the 123 patients, 30 (24.3%) of them died within 5 years, 28 due to comorbidities and only 2 due to recurrence and complications of the IC. The only factor that was associated increased mortality was age (72.5 11 years vs 78.6 years; P0.001). […] The mortality rate of IC is still high and the recurrence increases with time. In our study, mortality due to IC at the first admission was 5.9% and 7.4% five years later. The overall rates of mortality, including comorbidities were 8.8% and 31.1% respectively.
  • #25 Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score | Annals of Intensive Care | Full Text
    https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0395-5
    Bowel ischemia is a life-threatening emergency defined as an inadequate vascular perfusion leading to bowel inflammation resulting from impaired colonic/small bowel blood supply. […] The associated mortality reported in the literature is more than 75% for mesenteric ischemia and depends on the mucosal ischemic damage stage of the colon (Faviers classification): Stage I is an ischemia limited to the mucosa (0% mortality), stage II is an ischemia extended to the muscularis mucosa with large ulcerations, and stage III is a transmural ischemia with necrosis of the muscularis and possible perforation (mortality 75%). […] The main issue for physicians about bowel ischemia diagnosis lies in the absence of informative and specific clinical or biological signs leading to delayed management and resulting in a poorer prognosis, especially after cardiac surgery.
  • #26 Predictive Factors for Severe Outcomes in Ischemic Colitis
    https://www.gutnliver.org/journal/view.html?pn=search&uid=744&vmd=Full
    Ischemic colitis includes a wide clinical spectrum ranging from mild to severe forms. This study aimed to determine the factors that are related to the occurrence of severe ischemic colitis. […] In the comparison of comorbidities, the severe group had a higher ratio of chronic kidney disease than the mild group (p=0.001). […] A multivariate analysis showed that chronic kidney disease and high ECOG performance status scores were significant risk factors. […] If patients diagnosed with ischemic colitis are also treated for chronic kidney disease or have poor performance status, more attention and early intervention are necessary. […] The ECOG performance status score has been known to be closely related to the prognosis of patients with cancer in general. […] In conclusion, factors that can predict poor prognosis in ischemic colitis were comorbidity of chronic kidney disease and high ECOG performance status score. Therefore, it is necessary for patients with suspicious ischemic colitis to receive active treatment (e.g., surgery) at an early stage and to be observed carefully if they are treated with chronic kidney disease and if their performance status is poor overall.
  • #27 Ischemic Colitis: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/24513-ischemic-colitis
    Most people with acute ischemic colitis (75%) have a relatively mild and transient case that affects only the mucous lining in one segment. Most will recover fully with conservative treatment. […] A smaller percentage of people have a more complicated case that requires surgery. Those who have complications tend to be those with preexisting conditions, such as heart disease and kidney disease, which make surgery riskier and recovery more difficult. This group is statistically more at risk of unfavorable outcomes and death (about 40%), although the risk isn’t from ischemic colitis alone.
  • #28 Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score | Annals of Intensive Care | Full Text
    https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0395-5
    In the ischemia group, the postoperative mortality rate was 81.3% (n=39) vs. 7.3% (n=7) in the non-ischemia group. […] The clinical interest of this score for the diagnosis of bowel ischemia may be attributed to its impact on the management of patients, especially those with a high risk of bowel ischemia after cardiovascular surgery; earlier CT scan and colonoscopies with a concomitant decrease in mortality due to a more aggressive management. […] A biological scoring system based on PCT, ASAT, lactate, and myoglobin allows the diagnosis of bowel ischemia after cardiac surgery with high accuracy. This score could help clinician to propose an early diagnosis and to propose an early treatment in this high mortality disease.
  • #29 Factors predicting poor prognosis in ischemic colitis
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4087624/
    AIM: To determine the clinical, analytical and endoscopic factors related to ischemic colitis (IC) severity. […] CONCLUSION: The factors that can predict poor prognosis of IC are the absence of hematochezia, tachycardia and peritonism, anemia and hyponatremia and stenosis. […] Evolution of IC in patients depends on the severity of the presentation. Most mildly affected patients are asymptomatic after medical treatment. Severely affected patients and those that have strictures need to undergo surgery and have a higher morbidity and mortality rate. […] The possibility of establishing prognostic factors promptly is of great importance in deciding the best therapeutic strategy for each case. […] Logistic regression analysis showed that hematochezia was a weak predictor of mild IC, while signs of peritonism, tachycardia, anemia and hyponatremia were associated with severe IC.
  • #30 Predictive Factors for Severe Outcomes in Ischemic Colitis
    https://www.gutnliver.org/journal/view.html?pn=search&uid=744&vmd=Full
    Ischemic colitis includes a wide clinical spectrum ranging from mild to severe forms. This study aimed to determine the factors that are related to the occurrence of severe ischemic colitis. […] In the comparison of comorbidities, the severe group had a higher ratio of chronic kidney disease than the mild group (p=0.001). […] A multivariate analysis showed that chronic kidney disease and high ECOG performance status scores were significant risk factors. […] If patients diagnosed with ischemic colitis are also treated for chronic kidney disease or have poor performance status, more attention and early intervention are necessary. […] The ECOG performance status score has been known to be closely related to the prognosis of patients with cancer in general. […] In conclusion, factors that can predict poor prognosis in ischemic colitis were comorbidity of chronic kidney disease and high ECOG performance status score. Therefore, it is necessary for patients with suspicious ischemic colitis to receive active treatment (e.g., surgery) at an early stage and to be observed carefully if they are treated with chronic kidney disease and if their performance status is poor overall.
  • #31 Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period
    https://www.wjgnet.com/1007-9327/full/v19/i44/8042.htm
    Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period. […] The prognosis of patients with ischemic colitis is unknown. In this study we observed that recurrence rate of ischemic colitis was low (9.7% at 5 years). However, the mortality was high (31% at 5 years) and the only factor associated with mortality was age. […] Estimated IC recurrence rates were 2.9%, 5.1%, 8.1% and 9.7% at years 1, 2, 3 and 5 years, respectively. Five-year survival was 69% (93 of 135) and 24% (10 of 42 patients) died for causes related to the IC. […] The five-year recurrence rate of IC was low. On the other hand, mortality during follow-up was high and was not associated with ischemic colitis. […] Considering the course of the 123 patients, 30 (24.3%) of them died within 5 years, 28 due to comorbidities and only 2 due to recurrence and complications of the IC. The only factor that was associated increased mortality was age (72.5 11 years vs 78.6 years; P0.001). […] The mortality rate of IC is still high and the recurrence increases with time. In our study, mortality due to IC at the first admission was 5.9% and 7.4% five years later. The overall rates of mortality, including comorbidities were 8.8% and 31.1% respectively.

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hematochezja mioglobina śmiertelność wewnątrzszpitalna niedokrwistość poziom mleczanów interwencja chirurgiczna choroby współistniejące anemia przewlekła choroba nerek zwężenie jelita kolektomia hiponatremia ostre uszkodzenie nerek prokalcytonina tachykardia zapalenie niedokrwienne jelita grubego objawy otrzewnowe diagnostyka endoskopowa niedokrwienie ściany jelita skala ECOG