Prognostic factors affecting early colectomy in patients with moderate to severe ulcerative colitis treated with calcineurin inhibitors

Abstract

Calcineurin inhibitors (CNIs) such as cyclosporine A (CSA) and tacrolimus (FK506) are often used as a second-line drug for steroid-refractory or steroid-dependent patients with ulcerative colitis (UC). The aim of the present study was to determine the prognostic factors for early colectomy. A total of 85 hospitalized patients with UC (CSA, 50 patients; FK506, 35 patients) were enrolled. Colectomy carried out within 60 days of starting CNI therapy was defined as 'early colectomy'. To assess the prognostic factors affecting early colectomy, clinical practical variables, including the Onodera-prognostic nutritional index (O-PNI): 10xAlb+0.005× (total lymphocyte count), were analyzed. The results demonstrated that the significant factors predicting early colectomy were i) disease severity, ii) immunomodulator-naïve history, iii) lower serum hematocrit, iv) lower serum albumin and v) lower O-PNI. In addition, the significant factors predicting overall colectomy were as follows: i) C7-HRP positivity and ii) >10,000 mg of prednisolone used prior to the initiation of CNI treatment. The combination of hematocrit and O-PNI enhanced the prediction of early colectomy. Clinical variables such as hematocrit and O-PNI were the significant factors predicting colectomy. These results may be used as a guide to predict the outcome of patients with UC in clinical settings.

Nutritional Index as Prognostic Indicator in Patients Receiving Lenvatinib Treatment for Unresectable Hepatocellular Carcinoma

“…The O-PNI uses albumin and lymphocyte levels as nutrition-related factors, and was developed as a nutritional prognostic indicator [8], while it has also been used as a prognostic marker in cases with peritoneal dialysis [9], colectomy in ulcerative colitis [10], and renal cell carcinoma [11]. Onodera reported that resection and anastomosis of the gastrointestinal tract can be performed safely when the O-PNI is >45, while the same procedure may be dangerous when the value is between 45 and 40, and possibly contraindicated when ≤40 [8].…”

“…Onodera proposed Onodera's prognostic nutritional index (O-PNI), which is easily calculated with a formula that includes the serum albumin level and lymphocyte count, as a nutritional prognostic indicator in a report on 189 patients undergoing gastrointestinal surgery [8]. Thereafter, the O-PNI has been reported to be useful as a prognostic marker for patients undergoing peritoneal dialysis [9] or colectomy in ulcerative colitis [10], as well as for renal cell carcinoma patients [11].…”

Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn’s disease

“…The basal energy expenditure (BEE) was calculated using the Harris-Benedict equation [ 31 ]. For nutritional assessments, the subjective global assessment (SGA) [ 32 ], controlling nutritional status (CONUT) [ 33 ], malnutrition universal screening tool (MUST) [ 34 ], nutritional risk screening 2002 (NRS-2002) [ 35 ], and Onodera’s prognostic nutritional index (O-PNI) [ 36 , 37 ] were used. O-PNI was calculated based on the serum albumin level and total lymphocyte count, using the following equation: O-PNI = 10 × [serum albumin (g/dL) + 0.005 × total lymphocyte count (/mL)].…”

Predictors of mucosal healing during induction therapy in patients with acute moderate‐to‐severe ulcerative colitis

“…9,28,29 These results should be interpreted carefully because low Alb levels are considered to be an indicator of colectomy. 29 Furthermore, the half-life of TC (1-3 days) is much shorter than that of Alb (21 days). Additionally, serum Alb levels are also affected by leakage from the intestinal tract.…”

“…Several studies report that low Alb levels before treatment or early after treatment are correlated with early colectomy . These results should be interpreted carefully because low Alb levels are considered to be an indicator of colectomy . Furthermore, the half‐life of TC (1–3 days) is much shorter than that of Alb (21 days).…”