12 - Development of a Clinically Applicable Prognostication Severity Score for Colon Ischemia in Hospitalized Patients

Rabia Rizwan, MD¹, Waseem Amjad, MD², Paul Feuerstadt, MD, FACG³, AbdelKader Chaar, MD¹, Ahmad Nawaz, MD¹, Karthik Gnanapandithan, MD⁴, Abdul Q. Bhutta, MD⁵, Marc Fenster, MD⁶, Savio John, MD⁷, Kanika Sehgal, MBBS⁸, Lawrence Brandt, MD, MACG^9
1Yale University School of Medicine, New Haven, CT; ²Brockton Hospital, Brockton, MA; ³PACT Gastroenterology Center and Yale School of Medicine, Hamden, CT; ⁴Mayo Clinic Florida, Jacksonville, FL; ⁵University Gastroenterology, Portsmouth, RI; ⁶Montefiore, Bronx, NY; ⁷SUNY Upstate Medical University, Syracuse, NY; ⁸Yale-New Haven Hospital, New Haven, CT; ⁹Montefiore Medical Center, Bronx, NY

Introduction: Colon Ischemia (CI) manifests a range of severity from reversible to fulminant disease requiring colectomy or resulting in death. Our goal was to develop a 30-day prediction score to triage the risk of progression of severe disease to colectomy or mortality in patients hospitalized with CI.

Methods: A multicenter retrospective study of patients hospitalized with biopsy-proven CI from 1/2005 to 7/2017. Patients with age < 45 yrs, the extreme elderly ( > 90 yrs), and those with colon cancer were excluded. Patients requiring colectomy and/or dying within 30 days of presentation were classified as having severe disease. A multivariable Cox-proportional hazard model was used to identify risk factors for severe CI. Beta coefficients of independent risk factors were used to generate the scoring system. Coefficients were rounded to the nearest decimal value multiple of 0.25 to generate a Clinically Applicable Prognostication Severity Score for CI (CAPSSCI). We calculated area under receiver operating curve (AUROC) of predicted and observed severe CI.

Results: 713 pts with biopsy-proven CI met study criteria. Of these, 82 (11.3%) developed severe CI within 30 days of presentation. Their mean age was 70.1 ± 10.9 yrs, and 74.7% were male. The severe CI group had a higher percentage of women (41.5 vs. 23.3, p=0.001), coronary artery disease(CAD; 46.3 vs. 31.0, p=0.007) and COPD (18.3 vs. 9.8, p=0.030). The multivariable model showed the following to be associated with severe CI: ages 45 to 54 yrs and advanced age (compared to reference: 55 to 64 yrs); CAD (HR: 3.01, 95% CI: 1.10 – 8.30, p=0.03), shock index (HR: 5.65, 95% CI: 1.11 – 28.8, p=0.04), lower albumin, imaging findings of pan-colon and right-colon involvement, pneumatosis, and portal venous gas. A 45-point score (0 to 11.25 with 0.25 increment) CAPSSCI was generated using point estimates (β) of these risk factors. (Table 1) AUROC to predict severe CI was 0.90 (95% CI: 0.85 – 0.93) at 30 days, and 5-fold internal cross-validation AUROC to predict 30-day severe CI was 0.87 (95% CI: 84 – 0.94). A cut-off of 3.25 accurately calibrated the risk for severe CI (sensitivity = 80.65%, 95% CI: 75.57% – 85.72% and specificity= 81.68%, 95% CI: 76.72% – 86.65%). (Figure 1)

Discussion: CAPSSCI is a simple-to-use risk score integrating baseline clinical variables and available diagnostic data. Healthcare providers can use this calculation to easily assess risk for severe outcomes of CI in hospitalized patients and direct therapy based upon this risk




Disclosures:


Rabia Rizwan, MD¹, Waseem Amjad, MD², Paul Feuerstadt, MD, FACG³, AbdelKader Chaar, MD¹, Ahmad Nawaz, MD¹, Karthik Gnanapandithan, MD⁴, Abdul Q. Bhutta, MD⁵, Marc Fenster, MD⁶, Savio John, MD⁷, Kanika Sehgal, MBBS⁸, Lawrence Brandt, MD, MACG⁹, 12, Development of a Clinically Applicable Prognostication Severity Score for Colon Ischemia in Hospitalized Patients, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.