Predicting the need for colectomy in severe ulcerative colitis: a critical appraisal of clinical parameters and currently available biomarkers

• Published in: Gut Vol. 60; no. 1; pp. 3 - 9
• Main Authors: Travis, Simon, Satsangi, Jack, Lémann, Marc
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.01.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Acute severe colitis; Algorithms; Biological and medical sciences; Biomarkers - analysis; clinical decision-making; Colectomy; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - pathology; Colitis, Ulcerative - surgery; Contingency planning; Decision Making; Endoscopy; Gastroenterology. Liver. Pancreas. Abdomen; Humans; IBD clinical; IBD surgery; Inflammatory bowel disease; management; Medical sciences; Morbidity; Mortality; Multivariate analysis; Other diseases. Semiology; prediction; Prognosis; Severity of Illness Index; Steroids; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; ulcerative colitis; Treatment; Surgery; Gastroenterology; Biological marker; Digestive diseases; Intestinal disease; Colectomy; Colon; Inflammatory disease; Ulcerative colitis
• DOI: 10.1136/gut.2010.216895
• ISSN: 0017-5749

If prospective data from 15/49 patients who had an incomplete response to medical therapy can be extrapolated (judged by a stool frequency greater than three per day or visible blood in their stools on day 7), 40% came to colectomy within 6 months and 85% had a colectomy over the next decade, compared with 15% in those responding completely to medical therapy. 15 Ciclosporin and infliximab may reduce the risk of colectomy in the short term without compromising safety, 16 although care should be taken to distinguish between complications related to emergency colectomy and elective colectomy, but neither appear able to prevent colectomy in the long term. A stool frequency greater than 12 per day on day 2 was associated with 55% colectomy in a retrospective study of 189 admissions in 166 patients, 21 whereas a frequency greater than eight per day on day 3 of intensive treatment predicted colectomy in 85% (p<0.001) on that admission in a prospective analysis of 51 admissions. 19 Stool frequency has been validated in 128 children: in the only prospective study yet to compare different indices, the number of daily stools on day 3 (closely followed by the amount of blood in the stool) was the main factor identified in multivariate analysis associated with lack of response to intravenous steroids. 20 The value of this paediatric ulcerative colitis activity index (PUCAI) 22 to facilitate the decision about 'rescue' therapy has been demonstrated. 23 The change in stool frequency may also have predictive value.\n 37 57 The Edinburgh predictive index includes stool frequency, the presence of colonic dilatation and hypoalbuminaemia, derived from a retrospective study of 167 admissions, with a colectomy rate of 40%.