Key predictors of surgical intervention in patients with severe UC, PMC, and IC include rapidly progressive disease course, mucosal contact bleeding, ulcerative defects, colonic bleeding, and colonic dilation.
Surgically treated patients were significantly younger than those who received conservative therapy.
Rapidly progressive disease course was significantly associated with surgical intervention.
Mucosal contact bleeding on endoscopy was a significant predictor of surgical intervention.
Ulcerative defects on endoscopy were a significant predictor of surgical intervention.
Colonic bleeding as a complication was the strongest predictor of surgical intervention among complications analyzed.
Colonic dilation as a complication was significantly associated with surgical intervention.
The binary logistic regression predictive model demonstrated satisfactory discrimination with high sensitivity but moderate specificity.
This research examined 308 patients hospitalized with severe forms of three types of colon inflammation: ulcerative colitis, pseudomembranous colitis (often caused by C. difficile infection), and ischemic colitis. The study compared patients who ultimately needed surgery (108 patients) with those successfully treated with medications alone (200 patients), looking for warning signs that could predict who would need an operation. The study was conducted over a nine-year period (2015–2024) at a single institution. This research suggests that several factors are strongly linked to a patient needing surgery. Patients who needed surgery tended to be younger and had disease that worsened rapidly. During colonoscopy (a camera examination of the colon), finding that the lining bleeds when touched or has open ulcers also raised the likelihood of surgery. Among serious complications, active bleeding from the colon (about 6 times more likely to lead to surgery) and abnormal widening of the colon (about 3.7 times more likely) were the strongest warning signs. The researchers combined these factors into a predictive model that was very good at identifying patients who would need surgery (catching about 93% of surgical cases), though it also flagged many patients who ultimately did not need surgery. This research suggests that clinicians caring for patients with severe colitis can use these specific clinical, endoscopic, and complication-related warning signs to help identify earlier which patients are at high risk of requiring surgical intervention. Earlier identification of high-risk patients could potentially allow for faster decision-making and preparation for surgery when needed. The moderate overall accuracy of the model (AUC 0.700) indicates that while useful as a screening tool, it should be used alongside clinical judgment rather than as a standalone decision-making instrument.
Krotov G, Danilov M, Knyazev O, Tsvirkun V. (2026). [Predictors of surgical intervention in patients with ulcerative, pseudomembranous, and ischemic colitis].. Terapevticheskii arkhiv. https://doi.org/10.26442/00403660.2026.08.203723