A Scoring System to Determine Patients' Risk of Colectomy Within 1 Year After Hospital Admission for Acute Severe Ulcerative Colitis.

Autor:	Le Baut G; University Hospital of Caen, Department of Gastroenterology, Caen. Electronic address: lebaut.guillaume@gmail.com., Kirchgesner J; Sorbonne Université, Department of Gastroenterology, AP-HP, Hôpital Saint Antoine, Paris; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris. Electronic address: julien.kirchgesner@gmx.com., Amiot A; Department of Gastroenterology, Henri Mondor Hospital, APHP, Paris Est-Créteil (UPEC) Val de Marne University, Creteil; EA 7375 (EC2M3 research team), Paris Est-Créteil (UPEC) Val de Marne University, Creteil., Lefevre JH; Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris., Chafai N; Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris., Landman C; Sorbonne Université, Department of Gastroenterology, AP-HP, Hôpital Saint Antoine, Paris., Nion I; Sorbonne Université, Department of Gastroenterology, AP-HP, Hôpital Saint Antoine, Paris., Bourrier A; Sorbonne Université, Department of Gastroenterology, AP-HP, Hôpital Saint Antoine, Paris., Delattre C; Sorbonne Université, Department of Gastroenterology, AP-HP, Hôpital Saint Antoine, Paris., Martineau C; Sorbonne Université, Department of Gastroenterology, AP-HP, Hôpital Saint Antoine, Paris., Sokol H; Sorbonne Université, Department of Gastroenterology, AP-HP, Hôpital Saint Antoine, Paris; Sorbonne Universités, École Normale Supérieure, CNRS, INSERM, APHP Laboratoire des Biomolécules (LBM), Paris., Seksik P; Sorbonne Université, Department of Gastroenterology, AP-HP, Hôpital Saint Antoine, Paris; Sorbonne Universités, École Normale Supérieure, CNRS, INSERM, APHP Laboratoire des Biomolécules (LBM), Paris., Nguyen Y; Beaujon Hospital, Department of Internal Medicine, Clichy; Paris-Sud Université, INSERM U1018, Centre de Recherche en épidémiologie et santé des populations (CESP), Villejuif., Marion Y; University Hospital of Caen, Department of Surgery, Caen., Lebreton G; University Hospital of Caen, Department of Surgery, Caen., Carbonnel F; Department of Gastroenterology, Bicetre University Hospital, APHP, Université Paris Sud, le Kremlin Bicêtre, Paris, France., Viennot S; University Hospital of Caen, Department of Gastroenterology, Caen., Beaugerie L; Sorbonne Université, Department of Gastroenterology, AP-HP, Hôpital Saint Antoine, Paris; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2021 Aug; Vol. 19 (8), pp. 1602-1610.e1. Date of Electronic Publication: 2020 Jan 10.
DOI:	10.1016/j.cgh.2019.12.036
Abstrakt:	Background & Aims: There is consensus on the criteria used to define acute severe ulcerative colitis (ASUC) and on patient management, but it has been a challenge to identify patients at risk for colectomy based on data collected at hospital admission. We aimed to develop a system to determine patients' risk of colectomy within 1 y of hospital admission for ASUC based on clinical, biomarker, and endoscopy data. Methods: We performed a retrospective analysis of consecutive patients with ASUC treated with corticosteroids, ciclosporin, or tumor necrosis factor (TNF) antagonists and admitted to 2 hospitals in France from 2002 through 2017. Patients were followed until colectomy or loss of follow up. A total of 270 patients with ASUC were included in the final analysis, with a median follow-up time of 30 months (derivation cohort). Independent risk factors identified by Cox multivariate analysis were used to develop a system to identify patients at risk for colectomy 1 y after ASUC. We developed a scoring system based on these 4 factors (1 point for each item) to identify high-risk (score 3 or 4) vs low-risk (score 0) patients. We validated this system using data from an independent cohort of 185 patients with ASUC treated from 2006 through 2017 at 2 centers in France. Results: In the derivation cohort, the cumulative risk of colectomy was 12.3% (95% CI, 8.6-16.8). Based on multivariate analysis, previous treatment with TNF antagonists or thiopurines (hazard ratio [HR], 3.86; 95% CI, 1.82-8.18), Clostridioides difficile infection (HR, 3.73; 95% CI, 1.11-12.55), serum level of C-reactive protein above 30 mg/L (HR, 3.06; 95% CI, 1.11-8.43), and serum level of albumin below 30 g/L (HR, 2.67; 95% CI, 1.20-5.92) were associated with increased risk of colectomy. In the derivation cohort, the cumulative risks of colectomy within 1 y in patients with scores of 0, 1, 2, 3, or 4 were 0.0%, 9.4% (95% CI, 4.3%-16.7%), 10.6% (95% CI, 5.6%-17.4%), 51.2% (95% CI, 26.6%-71.3%), and 100%. Negative predictive values ranged from 87% (95% CI, 82%-91%) to 92% (95% CI, 88%-95.0%). Findings from the validation cohort were consistent with findings from the derivation cohort. Conclusions: We developed a scoring system to identify patients at low-risk vs high-risk for colectomy within 1 y of hospitalization for ASUC, based on previous treatment with TNF antagonists or thiopurines, C difficile infection, and serum levels of CRP and albumin. The system was validated in an external cohort. (Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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