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.

中文翻译：

---

用于确定急性重症溃疡性结肠炎入院后 1 年内患者结肠切除术风险的评分系统

背景与目标

在用于定义急性重症溃疡性结肠炎 (ASUC) 的标准和患者管理方面存在共识，但根据入院时收集的数据确定有结肠切除术风险的患者一直是一项挑战。我们的目标是开发一个系统，根据临床、生物标志物和内窥镜数据来确定 ASUC 入院后 1 年内患者进行结肠切除术的风险。

方法

我们对 2002 年至 2017 年在法国 2 家医院接受皮质类固醇、环孢素或肿瘤坏死因子 (TNF) 拮抗剂治疗的连续 ASUC 患者进行了回顾性分析。对患者进行随访直至结肠切除术或失访。最终分析共纳入 270 名 ASUC 患者，中位随访时间为 30 个月（衍生队列）。Cox 多变量分析确定的独立危险因素用于开发一个系统，以识别 ASUC 后 1 年有结肠切除术风险的患者。我们基于这 4 个因素（每个项目 1 分）开发了一个评分系统，以识别高风险（得分 3 或 4）与低风险（得分 0）患者。我们使用来自 2006 年至 2017 年在法国 2 个中心接受治疗的 185 名 ASUC 患者的独立队列数据验证了该系统。

结果

在推导队列中，结肠切除术的累积风险为 12.3%（95% CI，8.6-16.8）。基于多变量分析，先前使用 TNF 拮抗剂或硫嘌呤治疗（风险比 [HR]，3.86；95% CI，1.82–8.18），艰难梭菌感染（HR，3.73；95% CI，1.11-12.55），血清 C 反应蛋白水平高于 30 mg/L（HR，3.06；95% CI，1.11-8.43），血清白蛋白水平低于 30 g/L L（HR，2.67；95% CI，1.20-5.92）与结肠切除术风险增加相关。在推导队列中，评分为 0、1、2、3 或 4 分的患者 1 年内结肠切除术的累积风险分别为 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%）和 100%。阴性预测值范围为 87%（95% CI，82%–91%）至 92%（95% CI，88%–95.0%）。验证队列的结果与推导队列的结果一致。

结论

我们开发了一个评分系统，根据既往使用 TNF 拮抗剂或硫嘌呤治疗、艰难梭菌感染以及血清 CRP 和白蛋白水平，在 ASUC 住院 1 年内确定结肠切除术的低风险和高风险患者。该系统在外部队列中得到验证。