Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second‐line medical therapy or surgery

Ho, Gwo–Tzer; Mowat, Craig; Goddard, C.; Fennell, Janice; Shah, Neha; Prescott, R. J.; Satsangi, Jack

doi:10.1111/j.1365-2036.2004.01945.x

Cited by 256 publications

(229 citation statements)

References 22 publications

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“…Other "risk scores" have been developed including those incorporating other blood-related parameters including low albumin and "bandemia" that have also been shown to be associated with poor outcomes in severe UC ( 40,41 ). Studies have established that fecal markers such as an elevated fecal calprotectin have been associated with higher risk of relapse in both UC and CD, as well as with outcomes in acute severe UC ( Table 1 ) ( 42 ).…”

Section: Fecal Calprotectin and Fecal Lactoferrinmentioning

confidence: 99%

Using Markers in IBD to Predict Disease and Treatment Outcomes: Rationale and a Review of Current Status

Lichtenstein¹,

McGovern²

2016

Am J Gastroenterol Suppl

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Biomarkers, radiology fi ndings, and endoscopic studies, together with clinical assessment of patients with infl ammatory bowel disease, can be used to help determine prognosis, assess disease activity, and increasingly to inform treatment decision-making. This article reviews the current "state of the science" regarding the multitude of different tests that can be performed and how these can be used in the clinic to guide management. Initially, when patients present with symptoms suggestive of infl ammatory bowel disease (IBD), standard endoscopic studies and radiographic studies should be performed and the use of combinations of serologic and fecal markers may additionally be incorporated into patient assessment. Once the patient has a formal diagnosis, prognosis should be assessed and serologic evaluation may be used, but in conjunction with endoscopic and radiographic studies. Within the context of evaluating clinical predictors of disease (e.g., disease location, nutritional status, routine blood tests), early mucosal healing has been linked to better outcomes, and failure to heal the mucosa has been associated with poorer outcomes. Evaluation of response to therapy can be approximated with the use of biomarkers (e.g., C-reactive protein, fecal calprotectin, lactoferrin), and therapeutic drug monitoring has enabled us to assess levels of drug metabolites, drug levels, and antidrug antibodies to guide the ongoing management. Although there is not yet universal adoption of biomarkers to determine treatment choices (e.g., the use of anti-tumor necrosis factor therapy), biomarkers have enabled us to "fi ne tune" treatment of some patients with IBD. Establishing mechanisms of communicating these risks/benefi ts to patients will be a considerable challenge and remains a priority area of research.

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Section: Fecal Calprotectin and Fecal Lactoferrinmentioning

confidence: 99%

Using Markers in IBD to Predict Disease and Treatment Outcomes: Rationale and a Review of Current Status

Lichtenstein¹,

McGovern²

2016

Am J Gastroenterol Suppl

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“…This is likely due to the small numbers of patients on this treatment (8%) who subsequently develop ASUC and is a testament to its protective effects. 35 Multiple studies including two controlled trials have shown that treatment with these agents can reduce or eliminate steroid use over time and maintain long term steroid free remission. [16][17][18][19][20] The immunomodulator azathioprine used in combination with infliximab therapy in moderate-severe ulcerative colitis outpatients has also been demonstrated to increase clinical remission, clinical response and mucosal healing when compared with infliximab or thiopurine monotherapy.…”

Section: Univariate and Multivariate Analysis Of Clinical Radiographmentioning

confidence: 99%

“…Abdominal radiographic colonic diameter was defined as abnormal in this study as ≥ 5.5cm as this has been demonstrated in prior studies to correlate with medical therapy failure and colectomy. 35,44 CRP on day 3 of ≥ 45 mg/L was chosen as a cut-off as it is the key component of both the Oxford and Swedish adult indexes for predicting colectomy. 11,38,45 The same cut-off was used in evaluating CRP on day 1 in this study for consistency.…”

Section: Data Collectionmentioning

confidence: 99%

“…34 Of these patients 19-40 % will come to colectomy after failing medical therapy. 10,35,36 Over half the patients admitted with ASUC are taking immunosuppressive treatment at the time of admission. 34,35 Respected authors in this field have suggested that patients on immunosuppressive therapy at the time of ASUC may be at higher risk for colectomy than immunosupression naïve patients.…”

Section: Introductionmentioning

confidence: 99%

“…10,35,36 Over half the patients admitted with ASUC are taking immunosuppressive treatment at the time of admission. 34,35 Respected authors in this field have suggested that patients on immunosuppressive therapy at the time of ASUC may be at higher risk for colectomy than immunosupression naïve patients. 3,37 This study explores the question: Is the outcome of a patient treated oral steroids or immunomodulator therapy prior to admission comparable to a patient not on these agents?…”

Section: Introductionmentioning

confidence: 99%

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Effect of pre-admission immunosuppressive therapy and regional transfer versus metropolitan hospital presentation on colectomy rates in acute severe ulcerative colitis

Patrick¹

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Ulcerative colitis is a chronic idiopathic inflammatory disorder of the colon with a relapsing remitting course. It affects 40,000 Australian patients currently.1 During their disease course 1 in 5 of these patients develop a severe episode of colitis requiring hospital admission and a significant proportion of them 19-40 % require resection of the colon to remain healthy. 2 The colectomy rate of acute severe ulcerative colitis (ASUC) continues to remain high despite significant advances in medical therapy over the last three decades. Risk stratification and optimal treatment strategy remain clinical challenges. It has been suggested by some authors that patients established on immunosuppressive therapy at the time of severe ulcerative colitis are a higher risk for colectomy than those not on treatment.3 Over half the patients admitted for this condition are on treatment at the time of admission but the outcomes of these patients have not been well studied. In addition many patients are transferred to large tertiary metropolitan hospitals from smaller regional hospitals which lack inflammatory bowel disease or gastroenterology specialty input. The initial management of these patients is therefore undertaken in these regional hospitals and the effect of this on colectomy rates not currently known.This thesis firstly aimed to identify whether being on immunosuppressive treatment at the time of admission with ASUC increases the risk of colectomy. Secondly this thesis aimed to compare the colectomy rates of ASUC patients presenting initially to regional with those presenting directly to a metropolitan tertiary hospital. We aimed to identify the driving factors for any inequality to allow development of strategies to improve the outcome of regional patients with this condition.Our findings show that immunosuppressive therapy prior to admission with ASUC does not significantly increase the colectomy rate. Predictors of colectomy confirmed were colonic dilation ≥ 5.5cm, transfer from a regional hospital, CRP level ≥ 45 mg/ml on day 3 of admission, first presentation of ulcerative colitis and bowel action frequency ≥ 8 on day 3 of treatment. Knowledge of these key parameters allows the clinician to select high risk patients for early and aggressive rescue therapy, stomal therapist and colorectal surgeon review.In regards to our second aim we found that regional transfer patients were three times as likely to undergo colectomy as patients presenting directly to our metropolitan hospital at 30 days post admission. The primary factor identified was poor response to intravenous steroids. Predictors of colectomy in regional transfer patients identified were bowel frequency ≥ 8 on day 3 and CRP ≥ 45 mg/L on day 3 of therapy.3

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Fate of the Rectal Stump After Subtotal Colectomy for Ulcerative Colitis in the Era of Ileal Pouch–Anal Anastomosis

Munie¹,

Hyman²,

Osler³

2013

JAMA Surg

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Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second‐line medical therapy or surgery

Cited by 256 publications

References 22 publications

Using Markers in IBD to Predict Disease and Treatment Outcomes: Rationale and a Review of Current Status

Using Markers in IBD to Predict Disease and Treatment Outcomes: Rationale and a Review of Current Status

Effect of pre-admission immunosuppressive therapy and regional transfer versus metropolitan hospital presentation on colectomy rates in acute severe ulcerative colitis

Fate of the Rectal Stump After Subtotal Colectomy for Ulcerative Colitis in the Era of Ileal Pouch–Anal Anastomosis

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