Background

Faecal microbiota transplantation (FMT) has been shown to be effective for induction of remission in nearly 50% patients with active UC. At present, factors impacting the response to FMT in UC remain unclear.

Methods

Patients with active UC treated with FMT via colonoscopy at weeks 0, 2, 6, 10, 14, 18, and 22 between September 2015 and March 2019 were analysed. Response to FMT was defined as achievement of clinical remission (Mayo score ≤2, with each sub-score ≤ 1 and endoscopic subscore of 0) at week 22. Patient and disease characteristics and FMT-related factors, considered to affect response to FMT were evaluated in a multivariable logistic regression analysis to determine the predictors of response to FMT. A statistical model was subsequently developed for predicting the success of FMT.

Results

Out of 140 patients with active UC and treated with FMT [mean age 34.29 ± 11.51 years, 65.71% males (n = 92), mean total Mayo score 7.8 ± 2.26], 57 (40.71%) achieved clinical remission. Of the various factors analysed, disease extent E2 (OR 2.34, 95% CI 1.17–4.68, p = 0.016), endoscopic Mayo score 1 (OR 15.375, 95% CI 1.89–125.11, p = 0.011) or 2 (OR 2.12, 95% CI 1.06–4.25, p = 0.035) and number of FMT sessions ≥ 4 (OR 16.74, 95% CI 4.85–57.85, p < 0.001) were found to be associated with response to FMT. An estimated response score was developed and score ≥4 predicted response to FMT with an accuracy of 74.3% [sensitivity 64.79% (95% CI 52.54% to 75.76%); specificity 84.06% (95% CI 73.26% to 91.76%, AUROC 0.834)].Table 1.Baseline characteristics of patients (n = 140)Mean age (years) (mean ± SD)34.29 ± 11.51Males (n) (%)92 (65.71)Disease duration (years) (mean ± SD)4.71 ± 4.57Disease extent (n) (%) E126 (18.57) E259 (42.14) E355 (39.28)Disease Severity (n) (%) Moderate (Mayo score 6–9) Severe (Mayo score ≥10)108 (77.14) 32 (22.86)Mayo score (mean ± SD)7.8 ± 2.26Endoscopic Mayo score (mean ± SD)2.47 ± 0.62Number of FMT sessions (n) (mean ± SD)5.37 ± 2.68Faecal slurry retention time (h) (mean ± SD)3.11 ± 1.63Concomitant medications (n) (%) 5-ASA140 (100) Azathioprine69 (49.28) Corticosteroids114 (81.42) BiologicsNil Previous exposure to biologics (n) (%)29 (20.71)

Conclusion

Disease Extent E2, endoscopic mayo score 1 or 2, and number of FMT sessions ≥4 predict response to FMT in active UC. The prediction model has good discriminative power at identifying individuals likely to respond to FMT.

中文翻译：

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P358活动性溃疡性结肠炎患者对粪便微生物群移植反应的预测因子

背景

粪便菌群移植（FMT）已被证明在近50％的活动性UC患者中可有效诱导缓解。目前，尚不清楚影响UC对FMT反应的因素。

方法

分析了2015年9月至2019年3月之间在第0、2、6、10、14、18和22周通过结肠镜检查接受FMT治疗的活动性UC患者。对FMT的反应被定义为在22周时临床缓解的实现（Mayo评分≤2，每个亚评分≤1，内窥镜亚评分为0）是患者和疾病的特征以及与FMT相关的因素，被认为影响FMT的反应。在多变量logistic回归分析中进行评估，以确定对FMT反应的预测因子。随后开发了用于预测FMT成功的统计模型。

结果

在140名活动性UC并接受FMT治疗的患者中[平均年龄34.29±11.51岁，男性65.71％（n = 92），梅奥总平均评分7.8±2.26]，其中57名（40.71％）达到了临床缓解。在分析的各种因素中，疾病程度E2（OR 2.34，95％CI 1.17-4.68，p = 0.016），内窥镜Mayo评分1（OR 15.375，95％CI 1.89-125.11，p = 0.011）或2（OR 2.12，发现95％CI 1.06-4.25，p = 0.035）和FMT会话数≥4（或16.74，95％CI 4.85-57.85，p <0.001）与FMT反应相关。建立了估计的反应得分，对FMT的预测反应得分≥4，准确度为74.3％[敏感性64.79％（95％CI 52.54％至75.76％）；特异性84.06％（95％CI 73.26％至91.76％，AUROC 0.834）]。表1.患者的基线特征（n = 140）平均年龄（年）（平均值±SD）34.29±11.51男性（n）（％） 92（65。

结论

疾病范围E2，内窥镜下Mayo评分1或2，以及FMT疗程次数≥4可预测活动性UC对FMT的反应。预测模型在识别可能对FMT做出响应的个人方面具有很好的判别力。