Abstract
Background
Models to predict colectomy in ulcerative colitis (UC) are valuable for identification, clinical management, and follow-up of high-risk patients. Our aim was to develop a clinical ...predictive model based on admission data for one-year colectomy in adults hospitalized for severe UC.
Methods
We performed a retrospective analysis of patients hospitalized at a tertiary academic center for management of severe UC from 1/2013 to 4/2018. Multivariate regression was performed to identify individual predictors of one-year colectomy. Outcome probabilities of colectomy based on the prognostic score were estimated using a bootstrapping technique.
Results
Two hundred twenty-nine individuals were included in the final analytic cohort. Four independent variables were associated with one-year colectomy which were incorporated into a point scoring system: (+) 1 for single class biologic exposure prior to admission; (+) 2 for multiple classes of biologic exposure; (+) 1 for inpatient salvage therapy with cyclosporine or a TNF-alpha inhibitor; (+) 1 for age <40. The risk probabilities of colectomy within one year in patients assigned scores 1, 2, 3, and 4 were 9.4% (95% CI, 1.7–17.2), 33.7% (95% CI, 23.9–43.5), 58.5% (95% CI, 42.9–74.1), 75.0% (95% CI, 50.5–99.5). An assigned score of zero was a perfect predictor of no colectomy.
Conclusion
Risk factors most associated with one-year colectomy for severe UC included: prior biologic exposure, need for inpatient salvage therapy, and younger age. We developed a simple scoring system using these variables to identify and stratify patients during their index hospitalization.
Lay Summary
The one year risk of colectomy in patients hospitalized with ulcerative colitis increases if they are younger than 40-years-old, have used one or more biologic drugs in the past and/or receive an inpatient salvage (step-up) therapy during the hospitalization.
Predictive factors for colectomy in severe ulcerative colitis include: prior biologic exposure, need for inpatient salvage therapy and younger age.
Introduction
Long-standing inflammation of the colorectum in ulcerative colitis (UC) and Crohn’s disease (CD) has been associated with an increased risk of subsequent dysplasia and colorectal cancer. ...Historically, it was described that the neoplastic transformation in these inflammatory bowel diseases (IBDs) occurred via a different biologic pathway and not by the non-IBD polyp-cancer pathway and predictable lag time of progression. Therefore, prevention strategies have focused on the detection of dysplasia in flat mucosa, and existing guidelines have recommended performance of interval surveillance colonoscopies with random biopsies to identify such lesions with proctocolectomy when they are confirmed.
Discussion
The use of a new technology higher-resolution colonoscopies has led to the appreciation more recently that dysplasia in IBD may be visible with standard optical colonoscopy and can be identified in an even more sensitive manner using chromoendoscopy. Furthermore, emerging evidence favors the intuitive understanding that neoplastic transformation in IBD is linked to the degree of inflammation and that disease control may therefore modify this risk and its subsequent prevention approaches.
Conclusion
Future IBD cancer prevention strategies and timing of surgery in at-risk patients will require a better understanding of this evolving field.
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