Retrospective Cohort Study
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World J Gastroenterol. Dec 28, 2014; 20(48): 18367-18374
Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18367
Prognosis of ulcerative colitis differs between patients with complete and partial mucosal healing, which can be predicted from the platelet count
Asuka Nakarai, Jun Kato, Sakiko Hiraoka, Toshihiro Inokuchi, Daisuke Takei, Yuki Moritou, Mitsuhiro Akita, Sakuma Takahashi, Keisuke Hori, Keita Harada, Hiroyuki Okada, Kazuhide Yamamoto
Asuka Nakarai, Sakiko Hiraoka, Toshihiro Inokuchi, Daisuke Takei, Yuki Moritou, Mitsuhiro Akita, Sakuma Takahashi, Kazuhide Yamamoto, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
Jun Kato, Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-0012, Japan
Keisuke Hori, Keita Harada, Hiroyuki Okada, Department of Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
Author contributions: Nakarai A performed the research; Kato J, Hiraoka S, Inokuchi T, Takei D, Moritou Y, Akita M, Takahashi S, Hori K, and Harada K designed the research study; Nakarai A wrote the paper; Okada H and Yamamoto K contributed to the design of the study.
Correspondence to: Sakiko Hiraoka, MD, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. sakikoh@cc.okayama-u.ac.jp
Telephone: +81-86-235-7219 Fax: +81-86-225-5991
Received: April 8, 2014
Revised: June 11, 2014
Accepted: July 16, 2014
Published online: December 28, 2014
Abstract

AIM: To determine the difference in clinical outcome between ulcerative colitis (UC) patients with Mayo endoscopic subscore (MES) 0 and those with MES 1.

METHODS: UC patients with sustained clinical remission of 6 mo or more at the time of colonoscopy were examined for clinical outcomes and the hazard ratios of clinical relapse according to MES. Parameters, including blood tests, to identify predictive factors for MES 0 and slight endoscopic recurrence in clinically stable patients were assessed. Moreover, a receiver operating characteristic curve was generated, and the area under the curve was calculated to indicate the utility of the parameters for the division between complete and partial mucosal healing. All P values were two-sided and considered significant when less than 0.05.

RESULTS: A total of 183 patients with clinical remission were examined. Patients with MES 0 (complete mucosal healing: n = 80, 44%) were much less likely to relapse than those with MES 1 (partial mucosal healing: n = 89, 48%) (P < 0.0001, log-rank test), and the hazard ratio of risk of relapse in patients with MES 1 vs MES 0 was 8.17 (95%CI: 4.19-17.96, P < 0.0001). The platelet count (PLT) < 26 × 104/μL was an independent predictive factor for complete mucosal healing (OR = 4.1, 95%CI: 2.15-7.99). Among patients with MES 0 at the initial colonoscopy, patients of whom colonoscopy findings shifted to MES 1 showed significant increases in PLT compared to those who maintained MES 0 (3.8 × 104/μL vs -0.6 × 104/μL, P < 0.0001).

CONCLUSION: The relapse rate differed greatly between patients with complete and partial mucosal healing. A shift from complete to partial healing in clinically stable UC patients can be predicted by monitoring PLT.

Keywords: Ulcerative colitis, Mucosal healing, Platelet count, Mayo endoscopic subscore, Platelet count

Core tip: Mucosal healing has been recognized as the treatment goal of ulcerative colitis (UC). Although many previous reports defined mucosal healing as Mayo endoscopic subscore (MES) of 0 or 1, the difference in prognosis between patients with MES 0 and those with MES 1 has scarcely been evaluated. This paper indicated that the relapse rate differed greatly between patients with MES 0 and MES 1, and that the treatment goal of UC should be MES 0. We also demonstrated that a shift from MES 0 to MES 1 in clinically stable UC patients can be predicted by monitoring platelet count.