A retrospective study of 117 patients with ischemic colitis found that the C-reactive protein-to-albumin ratio predicted disease severity, with a threshold of 0.335 or greater identifying more extensive disease beyond simple mucosal involvement.

The study demonstrated that CT imaging findings closely correlated with disease extent—positive results appeared in all non-one-pass cases compared with just 18% of mild cases. Nearly all patients (99%) achieved clinical recovery with medical management alone, and none required surgery. The C-reactive protein-to-albumin ratio (CAR) showed moderate predictive accuracy, while a clinical scoring model by Shin et al. demonstrated stronger performance.

The cohort consisted predominantly of elderly women (mean age 65 years; 78% female), with abdominal pain and hematochezia as the primary presenting symptoms. Colonoscopy within 72 hours confirmed diagnosis in all cases, with left-sided colonic involvement most common. Disease classification revealed one-pass type in 86% of patients, circumferential involvement in 13%, and transmural disease in 1%, with no gangrenous cases observed. 94% of patients recovered within one week.

Hypertension was the most prevalent comorbidity, followed by cerebrovascular disease, diabetes mellitus, and coronary artery disease. Among medication users, antihypertensive therapy was most frequently reported, followed by antiplatelet agents, statins, and hypoglycemic drugs. Antibiotics were administered to 26% of patients—those presenting with leukocytosis.

While the Shin model demonstrated stronger performance, CAR offers practical advantages requiring only two routine laboratory values. Both tools showed weaker discrimination in elderly patients.

Study limitations include the single-center design and predominance of mild-to-moderate cases, potentially limiting generalizability to severe ischemic colitis.

The authors reported no conflicts of interest.

Source: BMC Gastroenterology