Retrospective Study
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World J Gastroenterol. Sep 21, 2014; 20(35): 12574-12580
Published online Sep 21, 2014. doi: 10.3748/wjg.v20.i35.12574
Parameters of a severe disease course in ulcerative colitis
Andreas Stallmach, Luisa Nickel, Thomas Lehmann, Bernd Bokemeyer, Martin Bürger, Dietrich Hüppe, Wolfgang Kruis, Susanna Nikolaus, Jan C Preiss, Andreas Sturm, Niels Teich, Carsten Schmidt
Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany
Thomas Lehmann, Zentrum für klinische Studien, Universitätsklinikum Jena, Jena 07747, Germany
Bernd Bokemeyer, Gastroenterologische Gemeinschaftspraxis, Minden 32423, Germany
Dietrich Hüppe, Gastroenterologische Gemeinschaftspraxis, Herne 44623, Germany
Wolfgang Kruis, Evangelisches Krankenhaus Kalk, Köln 51103, Germany
Susanna Nikolaus, Klinik für Innere Medizin, Christian Albrechts-Universität, Kiel 24105, Germany
Jan C Preiss, Medizinische Klinik I, Campus Benjamin Franklin, Charité, Berlin 12203, Germany
Andreas Sturm, Medizinische Klinik, Campus Berlin Mitte, Charité, Berlin 13353, Germany
Andreas Sturm, Krankenhaus Waldfriede, Berlin 14163, Germany
Niels Teich, Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig 04105, Germany
Author contributions: All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors participated in drafting the article or revising it critically for important intellectual content and all authors finally approved the manuscript to be published. Stallmach A and Schmidt C designed the study, participated in interpretation of data and drafted the manuscript; Nickel L carried out the study and performed the statistical analysis; Bürger M revised the manuscript, Lehmann T performed the statistical analysis; Bokemeyer B, Hüppe D, Kruis W, Nikolaus S, Preiss JC, Sturm A and Teich N participated in data collection.
Correspondence to: Andreas Stallmach, Professor, Dr. MED, Chief, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Erlanger Allee 101, Jena 07747, Germany. andreas.stallmach@med.uni-jena.de
Telephone: +49-3641-9324220 Fax: +49-3641-9324222
Received: March 3, 2014
Revised: May 12, 2014
Accepted: June 25, 2014
Published online: September 21, 2014
Abstract

AIM: To detect high risk patients with a progressive disease course of ulcerative colitis (UC) requiring immunosuppressive therapy (IT).

METHODS: A retrospective, multicenter analysis of 262 UC patients from eight German tertiary inflammatory bowel disease centres was performed. Patients were divided into two groups depending on the patients need to initiate immunosuppressive therapy in the disease course. A comparison between the two groups was made with regard to demographics, clinical and laboratory parameters obtained within three months after UC diagnosis and the response to first medical therapy. Using this data, a prognostic model was established to predict the individual patients probability of requiring an immunosuppressive therapy.

RESULTS: In 104 (39.7%) out of 262 patients, UC therapy required an immunosuppressive treatment. Patients in this group were significantly younger at time of diagnosis (HR = 0.981 ± 0.014 per year, P = 0.009), and required significantly more often a hospitalisation (HR = 2.5 ± 1.0, P < 0.001) and a systemic corticosteroid therapy at disease onset (HR = 2.4 ± 0.8, P < 0.001), respectively. Response to steroid treatment was significantly different between the two groups of patients (HR = 5.2 ± 3.9 to 50.8 ± 35.6 compared to no steroids, P = 0.016 to P < 0.001). Furthermore, in the IT group an extended disease (HR = 3.5 ± 2.4 to 6.1 ± 4.0 compared to proctitis, P = 0.007 to P = 0.001), anemia (HR = 2.2 ± 0.8, P < 0.001), thrombocytosis (HR = 1.9 ± 1.8, P = 0.009), elevated C-reactive protein (CRP) (HR = 2.1 ± 0.9, P < 0.001), and extraintestinal manifestations in the course of disease (HR = 2.6 ± 1.1, P = 0.004) were observed. Six simple clinical items were used to establish a prognostic model to predict the individual risk requiring an IT. This probability ranges from less than 2% up to 100% after 5 years. Using this, the necessity of an immunosuppressive therapy can be predicted in 60% of patients. Our model can determine the need for an immunosuppressive drug therapy or if a “watch and wait” approach is reasonable already early in the treatment course of UC.

CONCLUSION: Using six simple clinical parameters, we can estimate the patients individual risk of developing a progressive disease course.

Keywords: Clinical practice, Parameter, Prediction model, Ulcerative colitis, Inflammatory bowel disease

Core tip: We performed a retrospective study to identify patients at risk for a progressive disease course of ulcerative colitis, characterized by the necessity of immunosuppressive treatment. Personal data, clinical and laboratory parameters during the first 3 mo after ulcerative colitis diagnosis and effects of initial medical therapy were evaluated. Six simple clinical items were used to develop a prognostic model predicting such a progressive disease course. Thereby, our model can help in deciding if patients will need immunosuppressive drugs early in the disease course or if a careful watch and wait strategy is justified.