Prediction Of Severity And Outcomes Of Colon Ischemia Using A Novel Prognostic Model Based Upon CAR,Oakland Score And Fibrin Thrombi

ObjectiveTo identify risk factors of disease severity and between mild and severe colon ischemia(CI)patients and to improve clinical outcomes,this study aimed to explore a novel scoring model in China.MethodsRetrospective analyses of hospital records in Nanfang Hospital,Southern Medical University,Zhejiang Provincial Hospital and Zhuhai Hospital Affiliated with Jinan University between January 2015 and January 2020 were included.Baseline characteristics(Age,gender,hypertension,stroke,atrial fibrillation,etc),Clinical manifestations(fever,abdominal pain,diarrhea),mortality,Oakland score,laboratory tests(C-reactive protein,serum albumin and hemoglobin),colonoscopic distribution,and histopathology were collected.Risk factors of severe CI were determined by univariate and multivariate logistic regression and used for the predicting model.ResultsA total of 203 patients with biopsy-proven CI were included.Serum C-reactive protein(CRP)and albumin ratio(CAR)were much higher in the severe CI group compared with that of the mild CI group.(3.3±1.7;0.6±0.9,P<0.001).The Oakland score was much higher in the severe CI group(12.0±3.0;8.7±1.6,P<0.001).The histopathological finding of fibrin thrombi was an independent risk factor that predicted poor outcomes(20.0%vs.1.1%,P<0.001).Patients present with CAR≥3.3,Oakland score ≥12,and histopathological fibrin thrombi were independent risk factors.In addition,the final scoring model was Y=0.042 × Oakland score+1.040 ×CAR+3.412 × fibrin thrombi,the area under the curve(AUC)was 0.960(95%confidence interval:0.930-0.990),and the sensitivity and specificity of the novel scoring model were 95%and 92%,respectively.ConclusionsThe novel prognostic model was established to predict CI severity and clinical outcomes efficiently.