Clinical characteristics and predictive biomarkers for ulceration in ischemic colitis: A case-control study

With the aging global population, the incidence of ischemic colitis (IC) has risen steadily. Patients with ulcerative IC experience accelerated disease progression and poorer clinical outcomes. This study aimed to identify clinical characteristics and predictive biomarkers for ulceration in IC. We retrospectively evaluated 100 IC patients at Fuyang Campus of Zhejiang Provincial People's Hospital, China during January 2021 to November 2024. Patients were stratified into ulcer (n = 30) and non-ulcer (n = 70) groups based on endoscopic ulcer presence. Differences in clinical characteristics were analyzed between groups. Predictive factors for ulceration were identified using multivariable logistic regression. A total of 100 patients were included. The mean age in the ulcer group was 62.8 ± 9.7 years, with a sex ratio of 1:4 (male:female); the mean age in the non-ulcer group was 66.3 ± 10.6 years, with a sex ratio of 3:11 (male:female). Both groups presented with abdominal pain and hematochezia, with left colonic predominance. Univariate analysis associated ulceration with elevated white blood cell count (P < .05), C-reactive protein (CRP) level (P < .05), and d-dimer level (P = .020). On multivariable analysis, CRP level remained independently associated (odds ratio = 1.047, P = .026). Receiver operating characteristic analysis demonstrated CRP's predictive utility for ulceration (area under the curve = 0.716; 95% confidence interval: 0.595-0.838; P = .001), with an optimal cutoff of 26.6 mg/L (sensitivity 50.0%, specificity 91.4%). CRP level is an independent predictive factor of ulceration in IC. CRP level ≥26.6 mg/L increases the risk of ulceration in IC.