Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2017; 23(45): 8008-8016
Published online Dec 7, 2017. doi: 10.3748/wjg.v23.i45.8008
Albumin as a prognostic marker for ulcerative colitis
Nabeel Khan, Dhruvan Patel, Yash Shah, Chinmay Trivedi, Yu-Xiao Yang
Nabeel Khan, Yu-Xiao Yang, Section of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
Nabeel Khan, Chinmay Trivedi, Yu-Xiao Yang, Section of Gastroenterology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, United States
Dhruvan Patel, Department of Gastroenterology, Drexel University College of Medicine, Philadelphia, PA 19102, United States
Yash Shah, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, James J. Peters VA Medical Center, Bronx, NY 10468, United States
Author contributions: Khan N, Patel D, Shah Y and Yang YX have contributed to the study concept and design, analysis and interpretation of data as well as drafting of the manuscript; Khan N, Shah Y and Trivedi C have contributed to the acquisition of data; Yang YX has performed the statistical analysis; Trivedi C has contributed in the analysis and interpretation of data as well as drafting of the manuscript; Khan N and Yang YX have contributed to the critical revision of the manuscript for important intellectual content; Khan N has supervised the study.
Institutional review board statement: This study was reviewed and approved by Philadelphia VA Medical Center Institutional Review Board Committee.
Informed consent statement: This was a retrospective study and informed consent was not needed as no intervention was undertaken.
Conflict-of-interest statement: There were no conflicts of interest for this study.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at nabeel.khan@va.gov. Also, this was a retrospective cohort study and consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nabeel Khan, MD, Assistant Clinical Professor of Medicine, Chief, Section of Gastroenterology, Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, United States. nabeel.khan@va.gov
Telephone: +1-215-8234451 Fax: +1-215-8234179
Received: August 1, 2017
Peer-review started: August 4, 2017
First decision: September 5, 2017
Revised: October 10, 2017
Accepted: October 17, 2017
Article in press: October 17, 2017
Published online: December 7, 2017
Abstract
AIM

To evaluate the role of albumin at the time of ulcerative colitis (UC) diagnosis in predicting the clinical course of disease.

METHODS

Nationwide cohort of patients with newly diagnosed UC in the Veterans Affairs health care system was identified and divided into two categories: hypoalbuminemia (i.e., ≤ 3.5 gm/dL) or normal albumin levels (i.e., > 3.5 gm/dL) at the time of UC diagnosis. The exposure of interest was presence of hypoalbuminemia defined as albumin level ≤ 3.5 g/dL at the time of UC diagnosis. Patients were then followed over time to identify the use of ≥ 2 courses of corticosteroids (CS), thiopurines, anti-TNF medications and requirement of colectomy for UC management.

RESULTS

The eligible study cohort included 802 patients, but 92 (11.4%) patients did not have their albumin levels checked at the time of UC diagnosis, and they were excluded. A total of 710 patients, who had albumin levels checked at time of UC diagnosis, were included in our study. Amongst them, 536 patients had a normal albumin level and 174 patients had hypoalbuminemia. Patients with hypoalbuminemia at diagnosis had a higher likelihood of ≥ 2 courses of CS use (adjusted HR = 1.7, 95%CI: 1.3-2.3), higher likelihood of thiopurine or anti- TNF use (adjusted HR = 1.72, 95%CI: 1.23-2.40) than patients with normal albumin level at diagnosis. There was a trend of higher likelihood of colectomy in hypoalbuminemic patients, but it was not statistically significant (Adjusted HR = 1.7, 95%CI: 0.90-3.25).

CONCLUSION

Hypoalbuminemia at disease diagnosis can serve as a prognostic marker to predict the clinical course of UC at the time of diagnosis.

Keywords: Prognostic marker, Albumin, Ulcerative colitis, Disease course, Colectomy

Core tip: The current literature states that pancolitis, anemia and steroid use at ulcerative colitis (UC) diagnosis are considered poor prognostic features in UC. Ours is a first community based nationwide multi-center study on this subject evaluating serum albumin at the time of UC diagnosis as a prognostic marker. We identified a new easily measurable prognostic marker for the clinical course of UC, which in conjunction with other prognostic markers would help us identify a subset of UC patients who will eventually develop severe disease. This subset of patients may benefit from closer follow up and early escalation of therapy.