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P141 Characteristics and outcomes of acute colitis presenting via the emergency department in an Irish academic medical centre

O'Connell J.*1, Keohane S.1, McGreal-Bellone A.1, Naimimohasse S.1, McKiernan S.1, MacCarthy F.1, O'Toole D.1, Meaney J.2, Kevans D.1

1St James Hospital, Gastroenterology, Dublin, Ireland 2St James Hospital, Diagnostic Imaging, Dublin, Ireland

Background

A significant proportion of Emergency Department presentations with gastrointestinal symptoms, resulting in the performance of cross-sectional imaging, receive a radiological diagnosis of colitis. Data are few on the demographics and natural history of this patient cohort. We aimed to review the characteristics, outcomes and final diagnoses of new emergency department presentations with colitis diagnosed on cross-sectional imaging

Methods

An institutional radiology database was interrogated to identify cross-sectional imaging, which demonstrated a colitis, performed on patients admitted in 2015 via the Emergency Department of St James's Hospital. Radiology reports were reviewed to confirm the presence of colitis and exclude patients with known diagnoses of gastrointestinal disease. Baseline demographic data, information on inpatient investigations, final diagnoses and outcomes were recorded. Baseline data was analyzed for to look for significant predictors of morality or adverse outcomes. Adverse outcomes were defined as death, colectomy, or ICU admission during the inpatient stay.

Results

N=118 subjects were deemed eligible for inclusion: Age [median, range] 64 years [16.9–101.2]; 67% female. Proportions admitted under medical, surgical, gastroenterology and other services were 33%, 34%, 9% and 25% respectively. Median [range] admission duration was 10 days [1–241]. Laboratory parameters (median [range]) at admission were WCC 9.7×10–9/L [0.1–55], haemoglobin 11.8 g/dL [5.8–17.7], platelets 261×10–9/L [10–757], albumin 34 g/L [14–71], CRP 54 mg/L [1–307] and lactate 1.8 mmol/L [0.7–15]. Final colitis diagnoses were: undefined (35%), infectious (25%), reactive to other intra-abdominal pathology (13%), new IBD diagnosis (11%), ischaemic (9%), chemotherapy-associated (3%), diverticular (3%) and medication associated (1%). Colonic perforation, colectomy and mortality occurred in 1%, 5% and 13% of the cohort respectively. No clinical or laboratory variable associated significantly with mortality. Univariate analysis of baseline data showed Male Gender, Haemaglobin, Albumin and Lactae associated with adverse outcomes.

Table 1. Univariate analysis – Baseline clinical and biochemical factors associated with adverse outcome (n=118)

VariableOdds Ratio (95% CI)p value
Age (years)1.00 (0.98–1.03)0.530
Male gender3.09 (1.23–7.77)0.019
WCC1.00 (0.95–1.06)0.990
Haemoglobin0.67 (0.52–0.87)0.002
Platelet count1.00 (1.00–1.00)0.503
CRP1.00 (0.99–1.01)0.95
Albumin0.86 (0.80–0.93)0.0002
Lactate1.65 (1.13–2.42)0.009

Conclusion

There is a broad differential for patients presenting with an acute colitis via the Emergency Department with a significant proportion having no clearly defined aetiology following hospital admission. Considerable morbidity and mortality is observed in this patient cohort. Male gender, serum albumin and lactate concentrations are associated with adverse outcomes.