Analysis of clinical characteristics of 117 cases of ischemic colitis

Analysis of clinical characteristics of 117 cases of ischemic colitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of clinical characteristics of 117 cases of ischemic colitis Hong Shanshan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6618528/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Sep, 2025 Read the published version in BMC Gastroenterology → Version 1 posted 12 You are reading this latest preprint version Abstract OBJECTIVE: To retrospectively analyze and study the clinical features associated with 117 cases of ischemic colitis (IC), so as to guide the diagnosis and treatment in future clinics. METHODS: Through systematic case search, the clinical data of inpatients discharged from the Department of Gastroenterology of the Second People's Hospital of Anhui Province, with discharge diagnosis of IC, were collected from December 1, 2019 to December 31, 2024, and the general characteristics and related risk factors of IC patients were explored. RESULTS: A total of 136 IC patients were collected, and 117 patients were finally enrolled. Among them, there were 26 males and 91 females, with a male-to-female ratio of 1:3.5. The mean age was 65.18±13.56 years. The percentage of patients over 60 years old was 65.81% (77/117). There were 86 patients with underlying diseases, the most common underlying diseases were hypertension, cerebrovascular disease, type 2 diabetes mellitus, and coronary artery disease in that order. 69 patients had a history of medication use, the most common medication histories were antihypertensive, antiplatelet, statin, and hypoglycemic agents in that order. 81 (69.23%) patients had blood in the stool due to abdominal pain as the first and main symptom. Grouping by clinical staging was statistically significant for elevated neutrophils, elevated CRP, positive CT and CAR ratio. Grouping by age, statistically significant were underlying disease and drug history. Conclusion: 1. IC is predominantly seen in elderly female patients ≥60 years of age and endoscopic lesions are more common in the left hemicolon. 2. The most common underlying diseases in patients with IC were hypertension, cerebrovascular disease, type 2 diabetes mellitus, and coronary artery disease in that order. The most common medication histories in patients with IC were antihypertensive, antiplatelet, statin, and hypoglycemic agents in that order. 3. The main and first symptom of IC patients is abdominal pain and blood in the stool. 4. Neutrophil elevation, CRP elevation, CT positivity and CAR ratio were statistically higher in patients with other types of IC than in patients with one-pass type of IC, and may be used to predict the severity of lesions in patients with IC. Ischemic Colitis Risk Factors Clinical Characteristics Preface Ischemic bowel disease (ISBODI) is the most common vascular disorder of the gastrointestinal tract. It occurs as a result of ischemic, necrotizing injury to the intestine due to inadequate blood supply or obstruction of blood flow to any segment of the intestinal wall. Ischemic enteropathy can be divided into small bowel ischemia (mesenteric ischemia) and large bowel ischemia (colonic ischemia or Ischemic colitis, IC), of which IC is the most common ischemic enteropathy [ 1 ] . There are many causes of ischemic bowel disease, and common ones include mesenteric vascular atherosclerosis in the elderly, diabetes mellitus, hypertension, substance abuse, genetics, and a history of abdominal surgery, among others [ 2 – 5 ] . Currently, the diagnosis and severity staging of IC mainly rely on colonoscopy, but colonoscopy is an invasive operation, which is not tolerated by some elderly and frail patients or patients with cardiovascular, cerebrovascular, or severe pulmonary diseases. Several scholars have tried to find non-invasive and effective diagnostic and prognostic methods to replace invasive colonoscopy. Ai Xinbo [ 6 ] established a prognostic scoring model of CAR, Oakland scores combined with fibrin thrombosis to predict the severity and prognosis of IC. In this paper, we mainly studied and analyzed the relevant clinical characteristics of 117 cases of ischemic colitis, and combined with CAR and Oakland scores, we summarized the general characteristics of IC and related risk factors, so as to guide the future clinical diagnosis and treatment. Research Objects and Methods 1.1 Research subjects The clinical data of inpatients discharged from the Department of Gastroenterology of the Second People's Hospital of Anhui Province from December 1, 2019 to December 31, 2024 with a discharge diagnosis of IC were collected. A total of 136 cases were collected, and 19 cases without enteroscopy and normal enteroscopy were excluded, and 117 cases were finally enrolled. 1.2 Methods Through a systematic case search, clinical data such as gender, age, lesion extent, endoscopic staging, endoscopic manifestation, pathology, underlying disease, history of abdominal surgery, history of medication, history of smoking and drinking, clinical manifestations, laboratory findings, CT findings, and regression, etc., were collected from IC patients, and CAR and Oakland scores were performed. All patients met the diagnostic criteria of the Chinese Expert Guidelines for the Diagnosis and Treatment of Colonic Ischemia in the Elderly [ 7 ] . The count data were expressed as the number of cases n, and the one-way х² test was used for intergroup comparisons; the measurement data were expressed as the mean ± standard deviation ( \(\:\stackrel{-}{x}\) ±s), and the nonparametric test was used for intergroup comparisons of non-normally distributed measurements. There are many methods of IC staging, and this paper cites the clinical staging method of Shen Wenxiao et al [ 8 ] , which categorized IC into one-pass, circumferential, permeable, and gangrenous types, respectively (see Table 1 ). Due to the small sample size of the data, this paper was divided into two groups of one-pass type and other types, and the difference was considered statistically significant at P < 0.05. Table 1 Clinical typing of ischemic colitis Clinical staging Clinical staging Endoscopic presentation Spiral CT presentation One-pass Abdominal pain, diarrhea, blood in stool, pressure pains Longitudinal or lamellar congestion, bruising, erosion, and ulceration of the mucosa, evident on the mesenteric side Lesions of the intestinal canal with no obvious changes or eccentric thickening, edema and turbidity of the mesentery of the intestinal canal Circumferential Abdominal pain, diarrhea, blood in stool, tenderness, or mild rebound pain, or elevated D-dimers Mucosal congestion, edema, bruising, erosion, ulceration, bleeding, continuous fusion of lesions along the circumference of the intestinal wall, narrowing of the intestinal lumen No obvious changes in the diseased intestinal canal, or thickening of the circular intestinal wall or mesenteric edema, turbidity, or comedo Permeable Abdominal pain, blood in stool, diarrhea, elevated D-dimer, tenderness or mild rebound pain, edematous intestinal tubes may be detected. Mucosal congestion, bruising, edema and thickening (circumferential changes), intestinal rigidity, surface erosion or formation of ulcers, some intestinal luminal stenosis is obvious, and it is difficult to pass through the enteroscope Marked edema and thickening of the intestinal wall of the diseased intestinal tube, with circumferential changes, double-ring sign, bull's-eye sign, comb sign, pneumatization, and fluid accumulation Gangrenous Abdominal pain, diarrhea or bloody stools, muscle tension in the abdominal wall, tenderness, rebound pain, elevated or lowered white blood cell count, elevated D-dimer, decreased blood pressure Congestion, edema thickening, rigidity, bruising, erosion, ulceration, localized gray or blackening around the loop of the diseased intestinal canal Same as transmural type, gas, fluid or thrombus can be seen Results 2.1 General information A total of 136 IC patients were collected, and 19 patients were excluded due to lack of colonoscopic results or normal colonoscopic tips, and finally 117 patients were enrolled. Among them, there were 26 males and 91 females, with a male to female ratio of 1:3.5. The average age was 65.18 ± 13.56 years, of which the average age of males was 65.42 ± 11.67 years and that of females was 65.11 ± 14.11 years. The percentage of patients over 60 years old was 65.81% (77/117). There were 86 patients with underlying diseases, and among the underlying diseases, the number of patients suffering from hypertension was 54, 15 suffering from cerebrovascular diseases, 14 patients with type 2 diabetes mellitus, 12 patients with coronary artery disease, 5 patients with hemorrhoids, liver disease, and cancer, 3 patients with constipation, and 2 patients with renal disease. There were 69 cases of patients with medication history, of which 46 cases were taking antihypertensive drugs, 16 cases of antiplatelet drugs, 15 cases of statins, 11 cases of hypoglycemic drugs, 2 cases of laxatives, antiviral drugs, platelet-raising capsules and 1 case of anticancer drugs. 2.2 Clinical manifestations Eighty-one patients (69.23%) had abdominal pain and blood in stool as the first and main symptom. 11 patients (9.40%) had diarrhea. 10 patients (8.55%) had nausea and vomiting. 7 patients (5.98%) were admitted to the hospital because of blood in stool alone. Abdominal distension was present in 5 (4.27%) patients. 3 (2.56%) patients had combined constipation. 2.3 Statistical results 2.3.1 Grouping according to the clinical typing of IC was categorized into one-pass type and other types: the specific results are shown in Table 2 . Table 2 Statistical results of data related to IC patients with different clinical subtypes [number of cases (%)] Sports event One-pass(n = 101) Other types(n = 16) х² value P value Age (< 60 years) 35 5 0.071 0.790 Sex (male) 20 6 2.503 0.191 Extent of lesion (left hemicolon) 78 12 0.039 1.000 Underlying disease (1 underlying disease)* 31 7 2.129 0.345 History of abdominal surgery 27 6 0.791 0.382 Drug history 60 9 0.057 0.812 Smoking history 9 3 1.453 0.212 Drinking history 6 2 0.993 0.300 Decreased hemoglobin (Hb) 23 4 0.024 1.000 Elevated white blood cells 23 7 3.097 0.120 Elevated neutrophils 28 13 17.114 0.000 Elevated CRP 28 12 6.184 0.022 Elevated D-dimer 25 6 2.217 0.165 Elevated urea nitrogen 17 3 0.036 1.000 CT positive 14 14 38.775 0.000 *Note: The underlying diseases were divided into 3 groups: no underlying disease, 1 underlying disease, and 2 underlying diseases; P < 0.05 was considered the difference statistically significant. 2.3.2 Grouping by age was divided into age < 60 years group and age ≥ 60 years group: the specific results are shown in Table 3 . Table 3 Statistical results of data related to IC patients grouped by age [number of cases (%)] Sports event <60years(n = 40) ≥ 60years (n = 77) х² value P value Clinical typing (One-pass) 35 66 0.071 0.790 Sex (male) 9 17 0.003 0.958 Extent of lesion (left hemicolon) 31 59 0.011 0.915 Underlying disease (1 underlying disease)* 16 22 15.134 0.001 History of abdominal surgery 10 23 0.308 0.579 Drug history 17 52 6.818 0.009 Smoking history 4 8 0.004 1.000 Drinking history 4 4 0.954 0.443 Decreased hemoglobin (Hb) 8 19 0.186 0.666 Elevated white blood cells 8 22 0.877 0.349 Elevated neutrophils 11 30 1.311 0.252 Elevated CRP 12 28 0.078 0.781 Elevated D-dimer 8 23 1.572 0.210 Elevated urea nitrogen 6 14 0.188 0.665 CT positive 8 20 0.532 0.466 *Note: Underlying diseases were categorized into 3 groups: no underlying disease, 1 underlying disease, and 2 underlying diseases; P < 0.05 was considered a statistically significant difference. 2.3.3 Statistical results of CAR, Oakland score (Table 4) 2.3.4 Summary of results In summary, it is easy to see that the statistically significant groupings according to clinical typing were neutrophil elevation, CRP elevation, CT positivity, and CAR ratio. Patients with other types of IC had higher neutrophil elevation, CRP elevation, CT positivity ratio, and CAR ratio than patients with one-pass type of IC. However, grouping by age was statistically significant for underlying disease and drug history. Patients ≥ 60 years of age had a higher prevalence of underlying disease compared to patients < 60 years of age, as well as more patients with a history of medication use. Discussion IC is the most common among ischemic bowel diseases [ 9 ] . A foreign study [ 10 ] showed that the incidence of IC was about 6.1 cases/100,000 person-years adjusted for overall age and sex during 1976–1980, but the incidence increased about fourfold (about 22.9 cases/100,000 person-years) during 2005–2009. At present, there is less epidemiologic information related to the incidence of IC in China. As we know, the blood supply of the colon mainly depends on the superior mesenteric artery and inferior mesenteric artery, the diameter of inferior mesenteric artery is narrower, and the median abdominal artery is at an acute angle, in the intersection of the arterial blood supply of the splenic flexure and the junction of rectosigmoid junction is affected by the blood flow, it is the mesenteric vascular perfusion “watershed” area, easy to local ischemia, while the rectum is very rare due to the dual blood supply, and the rectum is very poor. The rectum is rarely ischemic due to the dual blood supply [ 11 ] . Whereas the main pathophysiological mechanism of IC is colonic ischemia due to obstruction or non-obstructive acute changes in the colonic microvasculature, reperfusion injury recruits a large number of immune cells to the injured tissues, which then leads to the development of an inflammatory response and persistent colonic cell and tissue damage [ 12 ] . Compared to the colonic mucosa, the small intestinal mucosa is more sensitive to ischemia but has great regenerative potential. In contrast, the colonic mucosa is less susceptible to ischemic injury, but once disrupted, recovery is slow [ 13 ] . The splenic flexure of the colon and the rectosigmoid junction are good sites for colonic ischemia, and the right half of the colon is also susceptible to ischemia during systemic hypoperfusion due to its vascular distribution [ 14 ] . In our study, IC lesions occurred in the left hemicolon in 90 patients (76.9%). There are more risk factors for IC and a study of 1560 patients with IC suggested that 73% of patients were > 65 years of age and the incidence increased with age [ 15 ] . Another study showed that the prevalence of IC in people under 40 years of age was 1.1/100000, while the prevalence of the disease was 107/100000 in people aged over 80.3 years [ 16 ] . All the above studies have shown that age is one of the risk factors for IC. This is in line with the results of the present study, which suggested that the mean age of IC patients was 65.18 ± 13.56 years, and 65.81% (77/117) of patients were over 60 years old. This may be related to the fact that older patients are more likely to have comorbidities with underlying diseases such as cardiovascular and cerebrovascular diseases. This study also confirmed that the prevalence of underlying diseases as well as medication history were higher in patients ≥ 60 years old. Some studies have shown [ 17 ] that older women are more prone to colonic ischemia, which may be related to female sex hormones and taking oral contraceptives. This study also confirms that a higher percentage of IC patients are female, with a male to female ratio of 1:3.5. Common causes of IC include vascular and non-vascular diseases. Vascular diseases include mesenteric arterial atherosclerosis, abdominal vascular malformations [ 18 ] , and colonic vascular injury ischemia due to diabetes mellitus, hypertension, coronary artery disease, pelvic and abdominal tumor surgery, and postoperative radiotherapy [ 19 ] . Most of the patients in this study had a combination of the above diseases. The largest number of patients with comorbid hypertensive disease was 62.8%, followed by cerebrovascular disease at 17.4%, comorbid diabetes mellitus at 16.3%, and coronary heart disease at 14.0%. It has been reported [ 20 ] that many types of drugs can cause IC, such as antihypertensive drugs, nonsteroidal anti-inflammatory drugs, contraceptives, diuretics, antibiotics, chemotherapeutic agents, interferons, immunosuppressants, and so on. In this study, antihypertensive drugs accounted for the highest percentage 66.7%, antiplatelet agents 23.2%, statins 21.7%, and hypoglycemic agents 15.9%. Patients with IC often present with sudden onset abdominal pain, diarrhea, abdominal distension, blood in the stool, and nausea [ 21 ] , depending on the location and severity of colonic ischemia. Abdominal pain is often described as “acute onset of cramping pain” and is often accompanied by an urge to defecate [ 22 ] . Eating aggravates the symptoms of abdominal pain. Therefore, loss of appetite and refusal to eat are common in patients with IC. Often, bloody stools may occur within 24 hours, but bleeding is often not severe. In patients with ischemia isolated to the right side of the colon, abdominal pain is usually severe with rectal bleeding and the prognosis is poor. Notably, these patients may not bleed at all [ 23 ] . In addition, diarrhea can be caused by leakage of intestinal fluid, injury and necrosis of the intestinal mucosa. Other common symptoms are flatulence, nausea, and vomiting [ 24 ] . The results of this study suggested that 81 (69.23%) patients had blood in stool as first and main symptom due to abdominal pain. 11 (9.40%) patients had diarrhea. 10 (8.55%) patients had nausea and vomiting. 7 (5.98%) patients were admitted to the hospital due to blood in stool alone. Abdominal distension was present in 5 (4.27%) patients. 3 (2.56%) patients had combined constipation. In this study, based on the method of Shen Wenxiao et al [ 8 ] , the clinical staging was improved into four staging types, i.e., one-pass, circumferential, transmural, and gangrenous, according to the clinical manifestations of ischemic colitis, endoscopic manifestations, and spiral CT manifestations. Among them, one-pass type and circumferential type are the same stage of the disease, and the lesions are in the mucosa and submucosa, the difference is that the scope of involvement is not the same; while transmural type involves the intrinsic muscular layer, and has a tendency of gangrene. The sample size of the study population in this paper was small, with only 1 case of the transmural type and 0 cases of the gangrenous type, so they were categorized into one-pass and other types for comparison. LI et al [ 25 ] retrospectively analyzed 3016 patients with IC and found that neutrophil count was associated with poor prognosis in patients with IC. Some studies have found that indicators of acute infections such as leukocyte count, percentage of neutrophils, and C-reactive protein have an early diagnostic value for IC [ 26 ] . HUANG [ 27 ] stated that an elevated D-dimer is suggestive for the diagnosis of IC. Leukocyte count > 15×10 9 /L, hemoglobin 20 g/L are risk factors for poor prognosis of IC. It has also been shown that blood leukocytes, CRP, PCT, blood creatinine, blood urea nitrogen, lactate dehydrogenase, and D-dimer may be elevated and hemoglobin and albumin may be decreased in patients with IC [ 28 ] . In this study, we found that neutrophil elevation and CRP elevation were statistically higher in patients with other types of IC than in patients with one-pass type of IC. This suggests that the inflammatory response is more pronounced in patients with other types of IC. Other elevated D-dimer, elevated urea nitrogen, elevated leukocytes, and decreased hemoglobin were all more prevalent in patients with other types of IC, but were not statistically significant. Abdominal CT is currently the imaging test of choice for the diagnosis of IC and localization and differential diagnosis. Abdominal CT in patients with IC may show thickening of the bowel, pelvic effusion, blurring of the fat gaps, and periintestinal exudates, etc., and CT examination may provide an important basis for determining the cause and clinical outcome of IC bowel segmentation [ 29 ] . Iacobellis et al [ 30 ] retrospectively analyzed the CT manifestations of 32 patients diagnosed with IC at different stages (i.e., acute, subacute, and chronic). Their findings suggest that CT-based methods are able to differentiate between occlusive and non-occlusive ischemic injuries by evaluating morpho-functional alterations associated with IC, and that these methods can also be used to assess the duration of ischemic injury. In the present study In this study, 94 patients were perfected with abdominal CT examination, and the positive rate of one-pass CT was 17.5%, and the positive rate of other types of CT was 100%, which was statistically significant when comparing the two groups. This also confirms that CT has an important role in the diagnosis of IC, especially in patients with moderate to severe IC. An increasing number of studies have shown that serum albumin also decreases dramatically in patients with severe infections. The CRP to albumin ratio (CAR), as a predictive score based on the inflammatory background, has been shown in an increasing number of clinical studies to have an important predictive value in the prognosis of acute pancreatitis, primary hepatocellular carcinoma, esophageal squamous cell carcinoma, and small-cell-type Lung carcinoma [ 31 – 32 ] . As a new laboratory test, CAR is considered to be more valuable in assessing the inflammatory status of patients compared to CRP and albumin. In addition, Wang et al. found that CAR was more consistent with disease prognosis in patients with acute coronary syndrome than CRP and albumin [ 33 ] . The authors hypothesized that high levels of CAR imply a greater likelihood of coronary vascular injury. Since ischemic enteritis has a very clear correlation with atherosclerosis, hypertension or peripheral vascular disease. Therefore, Ai Xinbo [ 6 ] suggested that high levels of serum CAR also correlate significantly with arteriovenous injury to colonic blood supplies such as mesenteric vessels, and may have a very sensitive predictive value similar to the clinical studies of acute coronary syndromes or the nature of aortic elasticity in the literature described above. Oakland score is a risk assessment index for acute lower gastrointestinal bleeding proposed by Oakland scholars in the United Kingdom, a multicenter study conducted by a team led by Professor Oakland, and the results of the paper were published in the top international journal GUT. This score is widely used in Europe to assess the clinical prognosis of patients with acute lower gastrointestinal bleeding [ 34 ] . Ai Xinbo [ 6 ] established a relevant model for predicting the prognosis of ischemic bowel disease by studying CAR and Oakland score. In this study, CAR and Oakland scores were also included in the correlation study of IC, drawing on the experience of previous researchers. The results showed that the CAR ratio was higher and statistically significant in patients with other types of IC, while the Oakland score was not significantly different between the two groups, and the CAR ratio and Oakland score were higher in patients with IC ≥ 60 years of age when grouped by age, but there was no statistical significance in the statistical analysis of the two groups. This suggests that the CAR ratio may be used to predict disease severity in IC patients. IC is a clinical topic that we must face, and with the rapid development of population aging, IC cases will increase significantly, and we must pay attention and raise vigilance. For elderly patients, especially elderly women, who have sudden onset of abdominal pain, blood in stool and other symptoms combined with hypertension, cerebrovascular disease, diabetes mellitus and other underlying diseases within 24 hours, we should be alert to the possibility of IC, improve laboratory tests, CT and other tests in a timely manner, and perform colonoscopy as early as possible to clarify the diagnosis and typing of IC, assess the severity of the disease in a timely manner, and give the most active and appropriate treatment. The vast majority of patients with early diagnosis and early treatment have a good prognosis. Summary 1. IC is mainly seen in elderly female patients ≥ 60 years of age, and endoscopic lesions are more common in the left hemicolon. 2. The most common underlying diseases in patients with IC are hypertension, cerebrovascular disease, type 2 diabetes mellitus, and coronary artery disease, and the most common medication histories in patients with IC are antihypertensive, antiplatelet, statin, and hypoglycemic agents, in that order. 3. The main and first symptom of IC patients is abdominal pain and blood in the stool. 4. Neutrophil elevation, CRP elevation, CT positivity, and CAR ratio are statistically higher in patients with other types of IC than in patients with one-pass type of IC, and may be used to predict the severity of lesions in patients with IC. Abbreviations IC Ischemic Colitis Hb Hemoglobin Declarations Acknowledgements We sincerely thank the editor and reviewers for their constructive and valuable comments, which have significantly improved the quality and clarity of our manuscript. We also gratefully acknowledge the availability of publicly accessible datasets, which were essential for the completion of this study. Author contributions Shanshan Hong contributed to the original concepts, design, data collection, data analysis and visualization as well as write the original manuscript. All authors read and approved the final manuscript. Funding This research did not receive any specific funding. Data availability All data generated or analysed during this study are included in this published article [and its supplementary information files]. Ethics approval and consent to participate This study strictly adhered to the ethical standards outlined in the Declaration of Helsinki. Informed consent was obtained from all participants to participate in this study. Ethical approval was obtained from the Anhui Second People's Hospital, the ethical committee. The ethics number is (R) 2025-054. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Monjur A. Ischemic bowel disease in 2021[J]. World J Gastroenterol, 2021, 27(29):4746-4762.[PMID:DOI: 10.3748/wjg.v27.i29.4746] Greenwald DA, Brandt LJ, Reinus JF. Ischemic bowel disease in the elderly. Gastroenterol Clin North Am 2001; 30: 445-473 [PMID: 11432300 DOI:10.1016/s0889-8553(05)70190-4] Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008; 95: 1245-1251 [PMID: 18720461 DOI:10.1002/bjs.6319] Vodusek Z, Feuerstadt P, Brandt LJ. Review article: the pharmacological causes of colon ischaemia.Aliment Pharmacol Ther 2019; 49: 51-63 [PMID: 30467871 DOI: 10.1111/apt.15052] Patil P, Panarelli NC. Educational Case: Ischemic Disorders of the Gut in Adult Patients. Acad Pathol 2019; 6: 2374289519888709 [PMID: 31799383 DOI:10.1177/2374289519888709] Ai XB, Liu SD. Prognostic scoring model of CAR, Oakland score combined with fibrin thrombosis for predicting the severity and prognosis of IC[D]. Guangzhou:Southern Medical University, 2023. Geriatric Digestive Assistance Group of the Gastroenterology Branch of the Chinese Medical Association, National Clinical Medical Research Center for Geriatric Diseases (People's Liberation Army General Hospital). Chinese expert guidance on the diagnosis and treatment of colonic ischemia in the elderly[J]. Chinese Journal of Internal Medicine, 2023, 62(6): 639-646.[DOI:10.3760/cma.j.cn112138-20220601-00421] Shen WX, Ju HH et al. Diagnosis and treatment analysis of 79 cases of ischemic colitis with different clinical subtypes[J]. Zhejiang Med 2022; 44(15):1653-1659.[DOI:10.12056/j.issn.1006-2785.2022.44.15.2022-1136] Monjur A. Ischemic bowel disease in 2021. World J Gastroenterol 2021; 27(29): 4746-4762. [DOI: 10.3748/wjg.v27.i29.4746] Yadav S, Dave M, Edakkanambeth Varayil J, Harmsen WS, Tremaine WJ, Zinsmeister AR, Sweetser SR, Melton LJ 3rd, Sandborn WJ, Loftus EV Jr. A population-based study of incidence, risk factors, clinical spectrum, and outcomes of ischemic colitis. Clin Gastroenterol Hepatol 2015; 13: 731-8.e1 [PMID: 25130936 DOI: 10.1016/j.cgh.2014.07.061] Tian Shuyang, Jin Haiyan. Advances in diagnosis and treatment of ischemic colitis. Yanbian University Medical Journal, 2022; 45(2): 132-135. [DOI:10.16068/j.1000-1824.2022.02.014] NIKOLICAL, KECKJO. Ischaemic colitis: uncertainty indiagnosis, pathphysiology and management[J]. ANZ J Surg, 2018, 88(4):278-283.[DOI:10.1111/ans.14237] Robinson JW, Mirkovitch V, Winistörfer B, Saegesser F. Response of the intestinal mucosa to ischaemia. Gut 1981; 22: 512-527 [PMID: 7021332 DOI: 10.1136/gut.22.6.512] Wu Banyan, Wang Gangshi, Yang Yunsheng. Chinese expert guidelines for the diagnosis and management of colonic ischemia in the elderly. Chinese Journal of Internal Medicine, 2023; 62(6):639-646. [DOI 10.3760/cma.j.cn112138-20220601-00421] Twohig PA, Desai A, Skeans J, et al. Quantifying risk factors for is-chemic colitis: a nationwide, retrospective cohort study [J]. Indian J Gastroenterol, 2020, 39(4):398-404. [DOI:10.1007/s12664-020-01049-4] Xu Y, Xiong L, Li Y, et al. Diagnostic methods and drug therapies in patients with ischemic colitis [J]. Int J Colorectal Dis, 2021, 36 (1): 47⁃56. [DOI: 10. 1007/s00384⁃020⁃03739⁃z] Hu Chonghui, Song Zejun, Yu Gengping, Jiang Po, Ren Yutang. Progress in the identification of risk factors for ischemic colitis. Journal of Gastroenterology and Hepatology, 2023; 32(6):690-692. [DOI:10. 3969 / j. issn. 1006⁃5709. 2023. 06. 018] CHEW KKY, LAW C, LEE D. Stercoral colitis：a rare cause of bowel ischaemia[J]. ANZ J Surg, 2021, 91(4)：E225-E226.[PMID: 32886414 DOI: 10.1111/ans.16293] NIKOLIC A L, KECK J O. Ischaemic colitis：uncertainty in diagnosis, pathophysiology and management[J]. ANZ J Surg, 2018, 88(4)：278-283. LI Yue, ZHAN Ming, DING Shigang. Research progress of drug-associated ischemic colitis[J]. Journal of Gastroenterology and Hepatology, 2022, 31(1):5-8. [DOI: 10.3969/j.issn.1006-5709.2022.01.002]. LONG Zhen-Pu, YU Yang-Hua, CHEN Xiao-Xiao, et al. Clinical characterization of ischemic colitis: with 101 reports[J]. Chinese Journal of General Surgery, 2020, 29(8): 979-986. [DOI: CNKI:SUN:ZPWZ.0.2020-08-012] Doulberis M, Panagopoulos P, Scherz S, et al. Update on ischemic colitis: from etiopathology to treatment including patients of intensive care unit[J]. Scand J Gastroenterol, 2016, 51(8): 893-902. [DOI：10.3109/00365521.2016.1162325] Brandt L J, Feuerstadt P. Beyond Low Flow: How I Manage Ischemic Colitis[J]. Am J Gastroenterol, 2016, 111(12): 1672-1674. [DOI: 10.1038/ajg.2016.456] Washington C, Carmichael J C. Management of ischemic colitis[J]. Clin Colon Rectal Surg, 2012, 25(4): 228-235. [DOI:10.1055/s-0032-1329534] LIS, LUO Y, WANG W, etal. A novel multiparameter scoring model for noninvasive early prediction of ischemic colitis: a multicenter, retrospective, and real-world study[J]. Clin Transl Gastroenterol, 2021, 12(6): e00370. [DOI:10.14309/ctg.0000000000000370] WU X, BAO Z. Population-based study of the clinical characteristics and risk factors of ischemic colitis[J]. TurkJ Gastroenterol, 2021, 32(4): 393-400. [DOI:10.5152/tjg.2021.20588] HUANG H, WANG H, LONG Z, et al. Factors influencing hospital stay duration for patients with mild ischemic colitis：a retrospective study[J]. Eur J Med Res, 2022, 27(1): 36. [DOI:10.1186/s40001-022-00665-4] PAN Yas, ZHAO Chen, LIN Mengjuan, et al. Study on the diagnostic and outcome prognostic value of relevant blood and blood biochemical indexes in ischemic colitis[J]. Journal of Difficult Diseases, 2019, 18(3): 251-255.[DOI:CNKI:SUN:YNBZ.0.2019-03-010] Gao Hao-Ran. Diagnostic analysis of abdominal CT in patients with ischemic bowel disease[J]. Imaging Vision, 2020, 4(7): 225-226.[DOI: CNKI:SUN:YXYY.0.2020-07-155] Iacobellis F, Berritto D, Fleischmann D, et al. CT findings in acute, subacute, and chronic ischemic colitis: suggestions for diagnosis[J]. Biomed Res Int, 2014, 2014: 895248. [DOI:10.1155/2014/895248] Kinoshita A, Onoda H, Imai N, et al. The Creactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 2015; 22:803. [DOI: 10.1245/s10434-014-4048-0] Wei XL, Wang FH, Zhang DS, et al. A novel inflammation-based prognostic score in esophageal squamous cell carcinoma: The C-reactive protein/albumin ratio. BMC Cancer 2015; 15:350. [DOI: 10.1186/s12885-015-1379-6] Wang W, Ren D, Wang CS, et al. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019; 13:811-20. [DOI: 10.2217/bmm-2018-0346] Oakland K, Guy R, Uberoi R, et al. Acute lower GI bleeding in the UK: patient characteristics, interventions and out comes in the fist nationwide audit . Gut 2018; 67: 654-62. [PMID: 28148540 DOI: 10.1136/gutjnl-2016-313428] Additional Declarations No competing interests reported. Supplementary Files data.pdf Cite Share Download PDF Status: Published Journal Publication published 03 Sep, 2025 Read the published version in BMC Gastroenterology → Version 1 posted Editorial decision: Revision requested 04 Jul, 2025 Reviews received at journal 03 Jul, 2025 Reviewers agreed at journal 03 Jul, 2025 Reviewers agreed at journal 02 Jul, 2025 Reviews received at journal 30 Jun, 2025 Reviewers agreed at journal 29 Jun, 2025 Reviewers agreed at journal 22 Jun, 2025 Reviewers invited by journal 18 Jun, 2025 Editor assigned by journal 18 Jun, 2025 Editor invited by journal 29 May, 2025 Submission checks completed at journal 27 May, 2025 First submitted to journal 27 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6618528","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":473306486,"identity":"08626d01-958f-4f3e-978a-c531afb15eae","order_by":0,"name":"Hong Shanshan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIie3QMUsDMRTA8YQnAeGdEVwaKn6GSOFq4dCvclLodIuLuBk40KXgev0WndTxhQxdircW6nBQcL7DpUMRb1dzujnkB297f3gJY0HwD+l23G77cSIBbNXsEpTSdCacoikN1L0Yn87M5FgV1JkAoaDLeYnx0b5xiTapPxnKRUU9fOVzhzHw5xI1I1432c/JqMg06bM3UE5cb66WaxyCATV79By2QkYpgjhw8DQoxBpHhgREvqRsD2t3kDkW91G8oKa0I6FUWyNc79Dtxf3ojn6RrDLt+HSiVd5+crEcoyps7n9Ludi8s21y+yCdreqb8wspc1s3nuQ73PxtPwiCIPjiE54zWykfyPc5AAAAAElFTkSuQmCC","orcid":"","institution":"Anhui Second People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hong","middleName":"","lastName":"Shanshan","suffix":""}],"badges":[],"createdAt":"2025-05-08 08:38:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6618528/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6618528/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12876-025-04224-z","type":"published","date":"2025-09-03T15:58:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90828053,"identity":"bbf395a9-eb9b-4ea3-a031-570f8d202af5","added_by":"auto","created_at":"2025-09-08 16:05:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":644833,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6618528/v1/aa5e7c00-a343-42f5-b504-e5965a812138.pdf"},{"id":85050551,"identity":"a8e72add-4018-470a-9c38-74e7e851d4db","added_by":"auto","created_at":"2025-06-20 11:24:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":141378,"visible":true,"origin":"","legend":"","description":"","filename":"data.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6618528/v1/f139c0e03f4704f2dec72416.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of clinical characteristics of 117 cases of ischemic colitis","fulltext":[{"header":"Preface","content":"\u003cp\u003eIschemic bowel disease (ISBODI) is the most common vascular disorder of the gastrointestinal tract. It occurs as a result of ischemic, necrotizing injury to the intestine due to inadequate blood supply or obstruction of blood flow to any segment of the intestinal wall. Ischemic enteropathy can be divided into small bowel ischemia (mesenteric ischemia) and large bowel ischemia (colonic ischemia or Ischemic colitis, IC), of which IC is the most common ischemic enteropathy\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. There are many causes of ischemic bowel disease, and common ones include mesenteric vascular atherosclerosis in the elderly, diabetes mellitus, hypertension, substance abuse, genetics, and a history of abdominal surgery, among others\u003csup\u003e[\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Currently, the diagnosis and severity staging of IC mainly rely on colonoscopy, but colonoscopy is an invasive operation, which is not tolerated by some elderly and frail patients or patients with cardiovascular, cerebrovascular, or severe pulmonary diseases. Several scholars have tried to find non-invasive and effective diagnostic and prognostic methods to replace invasive colonoscopy. Ai Xinbo\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e established a prognostic scoring model of CAR, Oakland scores combined with fibrin thrombosis to predict the severity and prognosis of IC. In this paper, we mainly studied and analyzed the relevant clinical characteristics of 117 cases of ischemic colitis, and combined with CAR and Oakland scores, we summarized the general characteristics of IC and related risk factors, so as to guide the future clinical diagnosis and treatment.\u003c/p\u003e"},{"header":"Research Objects and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Research subjects\u003c/h2\u003e \u003cp\u003eThe clinical data of inpatients discharged from the Department of Gastroenterology of the Second People's Hospital of Anhui Province from December 1, 2019 to December 31, 2024 with a discharge diagnosis of IC were collected. A total of 136 cases were collected, and 19 cases without enteroscopy and normal enteroscopy were excluded, and 117 cases were finally enrolled.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.2 Methods\u003c/h3\u003e\n\u003cp\u003eThrough a systematic case search, clinical data such as gender, age, lesion extent, endoscopic staging, endoscopic manifestation, pathology, underlying disease, history of abdominal surgery, history of medication, history of smoking and drinking, clinical manifestations, laboratory findings, CT findings, and regression, etc., were collected from IC patients, and CAR and Oakland scores were performed. All patients met the diagnostic criteria of the Chinese Expert Guidelines for the Diagnosis and Treatment of Colonic Ischemia in the Elderly\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. The count data were expressed as the number of cases n, and the one-way х\u0026sup2; test was used for intergroup comparisons; the measurement data were expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;s), and the nonparametric test was used for intergroup comparisons of non-normally distributed measurements. There are many methods of IC staging, and this paper cites the clinical staging method of Shen Wenxiao et al\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, which categorized IC into one-pass, circumferential, permeable, and gangrenous types, respectively (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Due to the small sample size of the data, this paper was divided into two groups of one-pass type and other types, and the difference was considered statistically significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical typing of ischemic colitis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical staging\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical staging\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEndoscopic presentation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpiral CT presentation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne-pass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdominal pain, diarrhea, blood in stool, pressure pains\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLongitudinal or lamellar congestion, bruising, erosion, and ulceration of the mucosa, evident on the mesenteric side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLesions of the intestinal canal with no obvious changes or eccentric thickening, edema and turbidity of the mesentery of the intestinal canal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCircumferential\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdominal pain, diarrhea, blood in stool, tenderness, or mild rebound pain, or elevated D-dimers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMucosal congestion, edema, bruising, erosion, ulceration, bleeding, continuous fusion of lesions along the circumference of the intestinal wall, narrowing of the intestinal lumen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo obvious changes in the diseased intestinal canal, or thickening of the circular intestinal wall or mesenteric edema, turbidity, or comedo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePermeable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdominal pain, blood in stool, diarrhea, elevated D-dimer, tenderness or mild rebound pain, edematous intestinal tubes may be detected.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMucosal congestion, bruising, edema and thickening (circumferential changes), intestinal rigidity, surface erosion or formation of ulcers, some intestinal luminal stenosis is obvious, and it is difficult to pass through the enteroscope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarked edema and thickening of the intestinal wall of the diseased intestinal tube, with circumferential changes, double-ring sign, bull's-eye sign, comb sign, pneumatization, and fluid accumulation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGangrenous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdominal pain, diarrhea or bloody stools, muscle tension in the abdominal wall, tenderness, rebound pain, elevated or lowered white blood cell count, elevated D-dimer, decreased blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCongestion, edema thickening, rigidity, bruising, erosion, ulceration, localized gray or blackening around the loop of the diseased intestinal canal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSame as transmural type, gas, fluid or thrombus can be seen\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.1 General information\u003c/h2\u003e \u003cp\u003eA total of 136 IC patients were collected, and 19 patients were excluded due to lack of colonoscopic results or normal colonoscopic tips, and finally 117 patients were enrolled. Among them, there were 26 males and 91 females, with a male to female ratio of 1:3.5. The average age was 65.18\u0026thinsp;\u0026plusmn;\u0026thinsp;13.56 years, of which the average age of males was 65.42\u0026thinsp;\u0026plusmn;\u0026thinsp;11.67 years and that of females was 65.11\u0026thinsp;\u0026plusmn;\u0026thinsp;14.11 years. The percentage of patients over 60 years old was 65.81% (77/117). There were 86 patients with underlying diseases, and among the underlying diseases, the number of patients suffering from hypertension was 54, 15 suffering from cerebrovascular diseases, 14 patients with type 2 diabetes mellitus, 12 patients with coronary artery disease, 5 patients with hemorrhoids, liver disease, and cancer, 3 patients with constipation, and 2 patients with renal disease. There were 69 cases of patients with medication history, of which 46 cases were taking antihypertensive drugs, 16 cases of antiplatelet drugs, 15 cases of statins, 11 cases of hypoglycemic drugs, 2 cases of laxatives, antiviral drugs, platelet-raising capsules and 1 case of anticancer drugs.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2.2 Clinical manifestations\u003c/h3\u003e\n\u003cp\u003eEighty-one patients (69.23%) had abdominal pain and blood in stool as the first and main symptom. 11 patients (9.40%) had diarrhea. 10 patients (8.55%) had nausea and vomiting. 7 patients (5.98%) were admitted to the hospital because of blood in stool alone. Abdominal distension was present in 5 (4.27%) patients. 3 (2.56%) patients had combined constipation.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical results\u003c/h2\u003e \u003cp\u003e2.3.1 Grouping according to the clinical typing of IC was categorized into one-pass type and other types: the specific results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStatistical results of data related to IC patients with different clinical subtypes [number of cases (%)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSports event\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOne-pass(n\u0026thinsp;=\u0026thinsp;101)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther types(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eх\u0026sup2; value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (\u0026lt;\u0026thinsp;60 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.790\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtent of lesion (left hemicolon)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderlying disease (1 underlying disease)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.345\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of abdominal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.791\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.812\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.300\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecreased hemoglobin (Hb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated white blood cells\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated neutrophils\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated CRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated D-dimer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated urea nitrogen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCT positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Note: The underlying diseases were divided into 3 groups: no underlying disease, 1 underlying disease, and 2 underlying diseases; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered the difference statistically significant.\u003c/p\u003e \u003cp\u003e2.3.2 Grouping by age was divided into age\u0026thinsp;\u0026lt;\u0026thinsp;60 years group and age\u0026thinsp;\u0026ge;\u0026thinsp;60 years group: the specific results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStatistical results of data related to IC patients grouped by age [number of cases (%)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSports event\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;60years(n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60years\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eх\u0026sup2; value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical typing (One-pass)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.790\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.958\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtent of lesion (left hemicolon)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.915\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderlying disease (1 underlying disease)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of abdominal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecreased hemoglobin (Hb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated white blood cells\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.349\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated neutrophils\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated CRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated D-dimer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated urea nitrogen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.665\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCT positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Note: Underlying diseases were categorized into 3 groups: no underlying disease, 1 underlying disease, and 2 underlying diseases; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered a statistically significant difference.\u003c/p\u003e\u003cp\u003e2.3.3 Statistical results of CAR, Oakland score (Table 4)\u003c/p\u003e\n\u003cdiv\u003e\n \u003cdiv align=\"left\"\u003e\u003cimg 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\"\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003e2.3.4 Summary of results\u003c/p\u003e\n\u003cp\u003eIn summary, it is easy to see that the statistically significant groupings according to clinical typing were neutrophil elevation, CRP elevation, CT positivity, and CAR ratio. Patients with other types of IC had higher neutrophil elevation, CRP elevation, CT positivity ratio, and CAR ratio than patients with one-pass type of IC. However, grouping by age was statistically significant for underlying disease and drug history. Patients ≥ 60 years of age had a higher prevalence of underlying disease compared to patients \u0026lt; 60 years of age, as well as more patients with a history of medication use.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIC is the most common among ischemic bowel diseases\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. A foreign study\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003eshowed that the incidence of IC was about 6.1 cases/100,000 person-years adjusted for overall age and sex during 1976–1980, but the incidence increased about fourfold (about 22.9 cases/100,000 person-years) during 2005–2009. At present, there is less epidemiologic information related to the incidence of IC in China. As we know, the blood supply of the colon mainly depends on the superior mesenteric artery and inferior mesenteric artery, the diameter of inferior mesenteric artery is narrower, and the median abdominal artery is at an acute angle, in the intersection of the arterial blood supply of the splenic flexure and the junction of rectosigmoid junction is affected by the blood flow, it is the mesenteric vascular perfusion “watershed” area, easy to local ischemia, while the rectum is very rare due to the dual blood supply, and the rectum is very poor. The rectum is rarely ischemic due to the dual blood supply\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Whereas the main pathophysiological mechanism of IC is colonic ischemia due to obstruction or non-obstructive acute changes in the colonic microvasculature, reperfusion injury recruits a large number of immune cells to the injured tissues, which then leads to the development of an inflammatory response and persistent colonic cell and tissue damage\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Compared to the colonic mucosa, the small intestinal mucosa is more sensitive to ischemia but has great regenerative potential. In contrast, the colonic mucosa is less susceptible to ischemic injury, but once disrupted, recovery is slow\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. The splenic flexure of the colon and the rectosigmoid junction are good sites for colonic ischemia, and the right half of the colon is also susceptible to ischemia during systemic hypoperfusion due to its vascular distribution\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. In our study, IC lesions occurred in the left hemicolon in 90 patients (76.9%). There are more risk factors for IC and a study of 1560 patients with IC suggested that 73% of patients were \u0026gt; 65 years of age and the incidence increased with age\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Another study showed that the prevalence of IC in people under 40 years of age was 1.1/100000, while the prevalence of the disease was 107/100000 in people aged over 80.3 years\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. All the above studies have shown that age is one of the risk factors for IC. This is in line with the results of the present study, which suggested that the mean age of IC patients was 65.18 ± 13.56 years, and 65.81% (77/117) of patients were over 60 years old. This may be related to the fact that older patients are more likely to have comorbidities with underlying diseases such as cardiovascular and cerebrovascular diseases. This study also confirmed that the prevalence of underlying diseases as well as medication history were higher in patients ≥ 60 years old. Some studies have shown\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003ethat older women are more prone to colonic ischemia, which may be related to female sex hormones and taking oral contraceptives. This study also confirms that a higher percentage of IC patients are female, with a male to female ratio of 1:3.5. Common causes of IC include vascular and non-vascular diseases. Vascular diseases include mesenteric arterial atherosclerosis, abdominal vascular malformations\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, and colonic vascular injury ischemia due to diabetes mellitus, hypertension, coronary artery disease, pelvic and abdominal tumor surgery, and postoperative radiotherapy\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Most of the patients in this study had a combination of the above diseases. The largest number of patients with comorbid hypertensive disease was 62.8%, followed by cerebrovascular disease at 17.4%, comorbid diabetes mellitus at 16.3%, and coronary heart disease at 14.0%. It has been reported\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e that many types of drugs can cause IC, such as antihypertensive drugs, nonsteroidal anti-inflammatory drugs, contraceptives, diuretics, antibiotics, chemotherapeutic agents, interferons, immunosuppressants, and so on. In this study, antihypertensive drugs accounted for the highest percentage 66.7%, antiplatelet agents 23.2%, statins 21.7%, and hypoglycemic agents 15.9%. Patients with IC often present with sudden onset abdominal pain, diarrhea, abdominal distension, blood in the stool, and nausea\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, depending on the location and severity of colonic ischemia. Abdominal pain is often described as “acute onset of cramping pain” and is often accompanied by an urge to defecate\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Eating aggravates the symptoms of abdominal pain. Therefore, loss of appetite and refusal to eat are common in patients with IC. Often, bloody stools may occur within 24 hours, but bleeding is often not severe. In patients with ischemia isolated to the right side of the colon, abdominal pain is usually severe with rectal bleeding and the prognosis is poor. Notably, these patients may not bleed at all\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. In addition, diarrhea can be caused by leakage of intestinal fluid, injury and necrosis of the intestinal mucosa. Other common symptoms are flatulence, nausea, and vomiting\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. The results of this study suggested that 81 (69.23%) patients had blood in stool as first and main symptom due to abdominal pain. 11 (9.40%) patients had diarrhea. 10 (8.55%) patients had nausea and vomiting. 7 (5.98%) patients were admitted to the hospital due to blood in stool alone. Abdominal distension was present in 5 (4.27%) patients. 3 (2.56%) patients had combined constipation.\u003c/p\u003e \u003cp\u003eIn this study, based on the method of Shen Wenxiao et al \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, the clinical staging was improved into four staging types, i.e., one-pass, circumferential, transmural, and gangrenous, according to the clinical manifestations of ischemic colitis, endoscopic manifestations, and spiral CT manifestations. Among them, one-pass type and circumferential type are the same stage of the disease, and the lesions are in the mucosa and submucosa, the difference is that the scope of involvement is not the same; while transmural type involves the intrinsic muscular layer, and has a tendency of gangrene. The sample size of the study population in this paper was small, with only 1 case of the transmural type and 0 cases of the gangrenous type, so they were categorized into one-pass and other types for comparison. LI et al\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e retrospectively analyzed 3016 patients with IC and found that neutrophil count was associated with poor prognosis in patients with IC. Some studies have found that indicators of acute infections such as leukocyte count, percentage of neutrophils, and C-reactive protein have an early diagnostic value for IC\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. HUANG\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e stated that an elevated D-dimer is suggestive for the diagnosis of IC. Leukocyte count \u0026gt; 15×10\u003csup\u003e9\u003c/sup\u003e /L, hemoglobin \u0026lt; 120 g/L, and C-reactive protein \u0026gt; 20 g/L are risk factors for poor prognosis of IC. It has also been shown that blood leukocytes, CRP, PCT, blood creatinine, blood urea nitrogen, lactate dehydrogenase, and D-dimer may be elevated and hemoglobin and albumin may be decreased in patients with IC\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. In this study, we found that neutrophil elevation and CRP elevation were statistically higher in patients with other types of IC than in patients with one-pass type of IC. This suggests that the inflammatory response is more pronounced in patients with other types of IC. Other elevated D-dimer, elevated urea nitrogen, elevated leukocytes, and decreased hemoglobin were all more prevalent in patients with other types of IC, but were not statistically significant. Abdominal CT is currently the imaging test of choice for the diagnosis of IC and localization and differential diagnosis. Abdominal CT in patients with IC may show thickening of the bowel, pelvic effusion, blurring of the fat gaps, and periintestinal exudates, etc., and CT examination may provide an important basis for determining the cause and clinical outcome of IC bowel segmentation\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Iacobellis et al\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e retrospectively analyzed the CT manifestations of 32 patients diagnosed with IC at different stages (i.e., acute, subacute, and chronic). Their findings suggest that CT-based methods are able to differentiate between occlusive and non-occlusive ischemic injuries by evaluating morpho-functional alterations associated with IC, and that these methods can also be used to assess the duration of ischemic injury. In the present study In this study, 94 patients were perfected with abdominal CT examination, and the positive rate of one-pass CT was 17.5%, and the positive rate of other types of CT was 100%, which was statistically significant when comparing the two groups. This also confirms that CT has an important role in the diagnosis of IC, especially in patients with moderate to severe IC. An increasing number of studies have shown that serum albumin also decreases dramatically in patients with severe infections. The CRP to albumin ratio (CAR), as a predictive score based on the inflammatory background, has been shown in an increasing number of clinical studies to have an important predictive value in the prognosis of acute pancreatitis, primary hepatocellular carcinoma, esophageal squamous cell carcinoma, and small-cell-type Lung carcinoma\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e–\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. As a new laboratory test, CAR is considered to be more valuable in assessing the inflammatory status of patients compared to CRP and albumin. In addition, Wang et al. found that CAR was more consistent with disease prognosis in patients with acute coronary syndrome than CRP and albumin\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. The authors hypothesized that high levels of CAR imply a greater likelihood of coronary vascular injury. Since ischemic enteritis has a very clear correlation with atherosclerosis, hypertension or peripheral vascular disease. Therefore, Ai Xinbo \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e suggested that high levels of serum CAR also correlate significantly with arteriovenous injury to colonic blood supplies such as mesenteric vessels, and may have a very sensitive predictive value similar to the clinical studies of acute coronary syndromes or the nature of aortic elasticity in the literature described above. Oakland score is a risk assessment index for acute lower gastrointestinal bleeding proposed by Oakland scholars in the United Kingdom, a multicenter study conducted by a team led by Professor Oakland, and the results of the paper were published in the top international journal GUT. This score is widely used in Europe to assess the clinical prognosis of patients with acute lower gastrointestinal bleeding\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Ai Xinbo\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e established a relevant model for predicting the prognosis of ischemic bowel disease by studying CAR and Oakland score. In this study, CAR and Oakland scores were also included in the correlation study of IC, drawing on the experience of previous researchers. The results showed that the CAR ratio was higher and statistically significant in patients with other types of IC, while the Oakland score was not significantly different between the two groups, and the CAR ratio and Oakland score were higher in patients with IC ≥ 60 years of age when grouped by age, but there was no statistical significance in the statistical analysis of the two groups. This suggests that the CAR ratio may be used to predict disease severity in IC patients.\u003c/p\u003e \u003cp\u003eIC is a clinical topic that we must face, and with the rapid development of population aging, IC cases will increase significantly, and we must pay attention and raise vigilance. For elderly patients, especially elderly women, who have sudden onset of abdominal pain, blood in stool and other symptoms combined with hypertension, cerebrovascular disease, diabetes mellitus and other underlying diseases within 24 hours, we should be alert to the possibility of IC, improve laboratory tests, CT and other tests in a timely manner, and perform colonoscopy as early as possible to clarify the diagnosis and typing of IC, assess the severity of the disease in a timely manner, and give the most active and appropriate treatment. The vast majority of patients with early diagnosis and early treatment have a good prognosis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"Summary","content":"\u003cp\u003e\u003cspan\u003e1. IC is mainly seen in elderly female patients\u0026thinsp;\u0026ge;\u0026thinsp;60 years of age, and endoscopic lesions are more common in the left hemicolon.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e2. The most common underlying diseases in patients with IC are hypertension, cerebrovascular disease, type 2 diabetes mellitus, and coronary artery disease, and the most common medication histories in patients with IC are antihypertensive, antiplatelet, statin, and hypoglycemic agents, in that order.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e3. The main and first symptom of IC patients is abdominal pain and blood in the stool.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e4. Neutrophil elevation, CRP elevation, CT positivity, and CAR ratio are statistically higher in patients with other types of IC than in patients with one-pass type of IC, and may be used to predict the severity of lesions in patients with IC.\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIC\u0026nbsp;Ischemic Colitis\u003c/p\u003e\n\u003cp\u003eHb Hemoglobin\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank the editor and reviewers for their constructive and valuable comments, which have significantly improved the quality and clarity of our manuscript. We also gratefully acknowledge the availability of publicly accessible datasets, which were essential for the completion of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShanshan Hong contributed to the original concepts, design, data collection, data analysis and visualization as well as write the original manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study strictly adhered to the ethical standards outlined in the Declaration of Helsinki. Informed consent was obtained from all participants to participate in this study. Ethical approval was obtained from the Anhui Second People's Hospital, the ethical committee. The ethics number is (R) 2025-054.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMonjur A. Ischemic bowel disease in 2021[J]. World J Gastroenterol, 2021, 27(29):4746-4762.[PMID:DOI: 10.3748/wjg.v27.i29.4746]\u003c/li\u003e\n\u003cli\u003eGreenwald DA, Brandt LJ, Reinus JF. Ischemic bowel disease in the elderly. Gastroenterol Clin North Am 2001; 30: 445-473 [PMID: 11432300 DOI:10.1016/s0889-8553(05)70190-4] \u003c/li\u003e\n\u003cli\u003eAcosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008; 95: 1245-1251 [PMID: 18720461 DOI:10.1002/bjs.6319] \u003c/li\u003e\n\u003cli\u003eVodusek Z, Feuerstadt P, Brandt LJ. Review article: the pharmacological causes of colon ischaemia.Aliment Pharmacol Ther 2019; 49: 51-63 [PMID: 30467871 DOI: 10.1111/apt.15052]\u003c/li\u003e\n\u003cli\u003ePatil P, Panarelli NC. Educational Case: Ischemic Disorders of the Gut in Adult Patients. Acad Pathol 2019; 6: 2374289519888709 [PMID: 31799383 DOI:10.1177/2374289519888709] \u003c/li\u003e\n\u003cli\u003eAi XB, Liu SD. Prognostic scoring model of CAR, Oakland score combined with fibrin thrombosis for predicting the severity and prognosis of IC[D]. Guangzhou:Southern Medical University, 2023.\u003c/li\u003e\n\u003cli\u003eGeriatric Digestive Assistance Group of the Gastroenterology Branch of the Chinese Medical Association, National Clinical Medical Research Center for Geriatric Diseases (People\u0026apos;s Liberation Army General Hospital). Chinese expert guidance on the diagnosis and treatment of colonic ischemia in the elderly[J]. Chinese Journal of Internal Medicine, 2023, 62(6): 639-646.[DOI:10.3760/cma.j.cn112138-20220601-00421]\u003c/li\u003e\n\u003cli\u003eShen WX, Ju HH et al. Diagnosis and treatment analysis of 79 cases of ischemic colitis with different clinical subtypes[J]. Zhejiang Med 2022; 44(15):1653-1659.[DOI:10.12056/j.issn.1006-2785.2022.44.15.2022-1136]\u003c/li\u003e\n\u003cli\u003eMonjur A. Ischemic bowel disease in 2021. World J Gastroenterol 2021; 27(29): 4746-4762. [DOI: 10.3748/wjg.v27.i29.4746]\u003c/li\u003e\n\u003cli\u003eYadav S, Dave M, Edakkanambeth Varayil J, Harmsen WS, Tremaine WJ, Zinsmeister AR, Sweetser SR, Melton LJ 3rd, Sandborn WJ, Loftus EV Jr. A population-based study of incidence, risk factors, clinical spectrum, and outcomes of ischemic colitis. Clin Gastroenterol Hepatol 2015; 13: 731-8.e1 [PMID: 25130936 DOI: 10.1016/j.cgh.2014.07.061]\u003c/li\u003e\n\u003cli\u003eTian Shuyang, Jin Haiyan. Advances in diagnosis and treatment of ischemic colitis. Yanbian University Medical Journal, 2022; 45(2): 132-135. [DOI:10.16068/j.1000-1824.2022.02.014]\u003c/li\u003e\n\u003cli\u003eNIKOLICAL, KECKJO. Ischaemic colitis: uncertainty indiagnosis, pathphysiology and management[J]. \u003cem\u003eANZ J Surg,\u003c/em\u003e 2018, 88(4):278-283.[DOI:10.1111/ans.14237]\u003c/li\u003e\n\u003cli\u003eRobinson JW, Mirkovitch V, Winist\u0026ouml;rfer B, Saegesser F. Response of the intestinal mucosa to ischaemia. Gut 1981; 22: 512-527 [PMID: 7021332 DOI: 10.1136/gut.22.6.512]\u003c/li\u003e\n\u003cli\u003eWu Banyan, Wang Gangshi, Yang Yunsheng. Chinese expert guidelines for the diagnosis and management of colonic ischemia in the elderly. Chinese Journal of Internal Medicine, 2023; 62(6):639-646. [DOI 10.3760/cma.j.cn112138-20220601-00421]\u003c/li\u003e\n\u003cli\u003eTwohig PA, Desai A, Skeans J, et al. Quantifying risk factors for is-chemic colitis: a nationwide, retrospective cohort study [J]. Indian J Gastroenterol, 2020, 39(4):398-404. [DOI:10.1007/s12664-020-01049-4]\u003c/li\u003e\n\u003cli\u003eXu Y, Xiong L, Li Y, et al. Diagnostic methods and drug therapies in patients with ischemic colitis [J]. Int J Colorectal Dis, 2021, 36 (1): 47⁃56. [DOI: 10. 1007/s00384⁃020⁃03739⁃z]\u003c/li\u003e\n\u003cli\u003eHu Chonghui, Song Zejun, Yu Gengping, Jiang Po, Ren Yutang. Progress in the identification of risk factors for ischemic colitis. Journal of Gastroenterology and Hepatology, 2023; 32(6):690-692. [DOI:10. 3969 / j. issn. 1006⁃5709. 2023. 06. 018]\u003c/li\u003e\n\u003cli\u003eCHEW KKY, LAW C, LEE D. Stercoral colitis：a rare cause of bowel ischaemia[J]. ANZ J Surg, 2021, 91(4)：E225-E226.[PMID: 32886414 DOI: 10.1111/ans.16293]\u003c/li\u003e\n\u003cli\u003eNIKOLIC A L, KECK J O. Ischaemic colitis：uncertainty in diagnosis, pathophysiology and management[J]. ANZ J Surg, 2018, 88(4)：278-283.\u003c/li\u003e\n\u003cli\u003eLI Yue, ZHAN Ming, DING Shigang. Research progress of drug-associated ischemic colitis[J]. Journal of Gastroenterology and Hepatology, 2022, 31(1):5-8. [DOI: 10.3969/j.issn.1006-5709.2022.01.002].\u003c/li\u003e\n\u003cli\u003eLONG Zhen-Pu, YU Yang-Hua, CHEN Xiao-Xiao, et al. Clinical characterization of ischemic colitis: with 101 reports[J]. Chinese Journal of General Surgery, 2020, 29(8): 979-986. [DOI: CNKI:SUN:ZPWZ.0.2020-08-012]\u003c/li\u003e\n\u003cli\u003eDoulberis M, Panagopoulos P, Scherz S, et al. Update on ischemic colitis: from etiopathology to treatment including patients of intensive care unit[J]. Scand J Gastroenterol, 2016, 51(8): 893-902. [DOI：10.3109/00365521.2016.1162325]\u003c/li\u003e\n\u003cli\u003eBrandt L J, Feuerstadt P. Beyond Low Flow: How I Manage Ischemic Colitis[J]. Am J Gastroenterol, 2016, 111(12): 1672-1674. [DOI: 10.1038/ajg.2016.456]\u003c/li\u003e\n\u003cli\u003eWashington C, Carmichael J C. Management of ischemic colitis[J]. Clin Colon Rectal Surg, 2012, 25(4): 228-235. [DOI:10.1055/s-0032-1329534]\u003c/li\u003e\n\u003cli\u003eLIS, LUO Y, WANG W, etal. A novel multiparameter scoring model for noninvasive early prediction of ischemic colitis: a multicenter, retrospective, and real-world study[J]. Clin Transl Gastroenterol, 2021, 12(6): e00370. [DOI:10.14309/ctg.0000000000000370]\u003c/li\u003e\n\u003cli\u003eWU X, BAO Z. Population-based study of the clinical characteristics and risk factors of ischemic colitis[J]. TurkJ Gastroenterol, 2021, 32(4): 393-400. [DOI:10.5152/tjg.2021.20588]\u003c/li\u003e\n\u003cli\u003eHUANG H, WANG H, LONG Z, et al. Factors influencing hospital stay duration for patients with mild ischemic colitis：a retrospective study[J]. Eur J Med Res, 2022, 27(1): 36. [DOI:10.1186/s40001-022-00665-4]\u003c/li\u003e\n\u003cli\u003ePAN Yas, ZHAO Chen, LIN Mengjuan, et al. Study on the diagnostic and outcome prognostic value of relevant blood and blood biochemical indexes in ischemic colitis[J]. Journal of Difficult Diseases, 2019, 18(3): 251-255.[DOI:CNKI:SUN:YNBZ.0.2019-03-010]\u003c/li\u003e\n\u003cli\u003eGao Hao-Ran. Diagnostic analysis of abdominal CT in patients with ischemic bowel disease[J]. Imaging Vision, 2020, 4(7): 225-226.[DOI: CNKI:SUN:YXYY.0.2020-07-155]\u003c/li\u003e\n\u003cli\u003eIacobellis F, Berritto D, Fleischmann D, et al. CT findings in acute, subacute, and chronic ischemic colitis: suggestions for diagnosis[J]. Biomed Res Int, 2014, 2014: 895248. [DOI:10.1155/2014/895248]\u003c/li\u003e\n\u003cli\u003eKinoshita A, Onoda H, Imai N, et al. The Creactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 2015; 22:803. [DOI: 10.1245/s10434-014-4048-0] \u003c/li\u003e\n\u003cli\u003eWei XL, Wang FH, Zhang DS, et al. A novel inflammation-based prognostic score in esophageal squamous cell carcinoma: The C-reactive protein/albumin ratio. BMC Cancer 2015; 15:350. [DOI: 10.1186/s12885-015-1379-6]\u003c/li\u003e\n\u003cli\u003eWang W, Ren D, Wang CS, et al. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019; 13:811-20. [DOI: 10.2217/bmm-2018-0346]\u003c/li\u003e\n\u003cli\u003eOakland K, Guy R, Uberoi R, et al. Acute lower GI bleeding in the UK: patient characteristics, interventions and out comes in the fist nationwide audit . Gut 2018; 67: 654-62. [PMID: 28148540 DOI: 10.1136/gutjnl-2016-313428]\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ischemic Colitis, Risk Factors, Clinical Characteristics","lastPublishedDoi":"10.21203/rs.3.rs-6618528/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6618528/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOBJECTIVE: To retrospectively analyze and study the clinical features associated with 117 cases of ischemic colitis (IC), so as to guide the diagnosis and treatment in future clinics.\u003c/p\u003e\n\u003cp\u003eMETHODS: Through systematic case search, the clinical data of inpatients discharged from the Department of Gastroenterology of the Second People's Hospital of Anhui Province, with discharge diagnosis of IC, were collected from December 1, 2019 to December 31, 2024, and the general characteristics and related risk factors of IC patients were explored.\u003c/p\u003e\n\u003cp\u003eRESULTS: A total of 136 IC patients were collected, and 117 patients were finally enrolled. Among them, there were 26 males and 91 females, with a male-to-female ratio of 1:3.5. The mean age was 65.18±13.56 years. The percentage of patients over 60 years old was 65.81% (77/117). There were 86 patients with underlying diseases, the most common underlying diseases were hypertension, cerebrovascular disease, type 2 diabetes mellitus, and coronary artery disease in that order. 69 patients had a history of medication use, the most common medication histories were antihypertensive, antiplatelet, statin, and hypoglycemic agents in that order. 81 (69.23%) patients had blood in the stool due to abdominal pain as the first and main symptom. Grouping by clinical staging was statistically significant for elevated neutrophils, elevated CRP, positive CT and CAR ratio. Grouping by age, statistically significant were underlying disease and drug history.\u003c/p\u003e\n\u003cp\u003eConclusion:\u003c/p\u003e\n\u003cp\u003e1. IC is predominantly seen in elderly female patients ≥60 years of age and endoscopic lesions are more common in the left hemicolon.\u003c/p\u003e\n\u003cp\u003e2. The most common underlying diseases in patients with IC were hypertension, cerebrovascular disease, type 2 diabetes mellitus, and coronary artery disease in that order. The most common medication histories in patients with IC were antihypertensive, antiplatelet, statin, and hypoglycemic agents in that order.\u003c/p\u003e\n\u003cp\u003e3. The main and first symptom of IC patients is abdominal pain and blood in the stool.\u003c/p\u003e\n\u003cp\u003e4. Neutrophil elevation, CRP elevation, CT positivity and CAR ratio were statistically higher in patients with other types of IC than in patients with one-pass type of IC, and may be used to predict the severity of lesions in patients with IC.\u003c/p\u003e","manuscriptTitle":"Analysis of clinical characteristics of 117 cases of ischemic colitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-20 11:24:05","doi":"10.21203/rs.3.rs-6618528/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-04T05:27:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-03T17:35:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250985104023604695757099369073354544502","date":"2025-07-03T17:23:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15679321836526995797888474447528281405","date":"2025-07-02T16:05:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-30T12:25:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78897670715236449363569897070810338244","date":"2025-06-29T21:56:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12527787490322985712085837306545587692","date":"2025-06-22T21:03:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-18T18:13:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-18T07:10:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-29T09:25:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-27T07:35:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-05-27T07:34:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"13477c96-bf07-4043-b464-ca0495e58d6f","owner":[],"postedDate":"June 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-08T16:03:16+00:00","versionOfRecord":{"articleIdentity":"rs-6618528","link":"https://doi.org/10.1186/s12876-025-04224-z","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2025-09-03 15:58:01","publishedOnDateReadable":"September 3rd, 2025"},"versionCreatedAt":"2025-06-20 11:24:05","video":"","vorDoi":"10.1186/s12876-025-04224-z","vorDoiUrl":"https://doi.org/10.1186/s12876-025-04224-z","workflowStages":[]},"version":"v1","identity":"rs-6618528","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6618528","identity":"rs-6618528","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}