[Predictors of surgical intervention in patients with ulcerative, pseudomembranous, and ischemic colitis]

To compare surgical and conservative treatment outcomes in patients with severe and fulminant ulcerative colitis (UC), pseudomembranous colitis (PMC), and ischemic colitis (IC) and to identify predictors of surgical intervention.

A retrospective cohort study was conducted between 2015 and 2024 and included 308 patients with severe and fulminant UC, PMC, and IC. Surgical treatment was performed in 108 patients, while 200 received conservative therapy. Clinical and demographic data, endoscopic and imaging findings, complications, and outcomes were analyzed. Predictors of surgical intervention were identified using binary logistic regression with calculation of odds ratios (ORs) and 95% confidence intervals (CIs). Model discrimination was assessed using ROC analysis.

Surgically treated patients were younger (p=0.025) and more frequently had a rapidly progressive disease course (OR 2.85, 95% CI 1.65-4.92; p<0.001). Endoscopic predictors of surgery included mucosal contact bleeding (OR 1.99, p=0.020) and ulcerative defects (OR 1.97; p=0.012). Among complications, colonic bleeding (OR 6.33; p<0.001) and colonic dilation (OR 3.67; p=0.013) were significantly associated with surgical intervention. The predictive model demonstrated satisfactory discrimination (AUC 0.700; p<0.001) with high sensitivity (92.9%) and moderate specificity (33.7%).

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.