Cesarini Monica, Collins Gary S, Rönnblom Anders, Santos Antonieta, Wang Lai Mun, Sjöberg Daniel, Parkes Miles, Keshav Satish, Travis Simon P L
Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK.
Dipartimento di Medicina Interna e Specialità Mediche, 'Sapienza', University of Rome, Rome, Italy.
J Crohns Colitis. 2017 Mar 1;11(3):335-341. doi: 10.1093/ecco-jcc/jjw159.
Acute severe colitis [ASC] is associated with major morbidity. We aimed to develop and externally validate an index that predicted ASC within 3 years of diagnosis.
The development cohort included patients aged 16-89 years, diagnosed with ulcerative colitis [UC] in Oxford and followed for 3 years. Primary outcome was hospitalization for ASC, excluding patients admitted within 1 month of diagnosis. Multivariable logistic regression examined the adjusted association of seven risk factors with ASC. Backwards elimination produced a parsimonious model that was simplified to create an easy-to-use index. External validation occurred in separate cohorts from Cambridge, UK, and Uppsala, Sweden.
The development cohort [Oxford] included 34/111 patients who developed ASC within a median 14 months [range 1-29]. The final model applied the sum of 1 point each for extensive disease, C-reactive protein [CRP] > 10mg/l, or haemoglobin < 12g/dl F or < 14g/dl M at diagnosis, to give a score from 0/3 to 3/3. This predicted a 70% risk of developing ASC within 3 years [score 3/3]. Validation cohorts included different proportions with ASC [Cambridge = 25/96; Uppsala = 18/298]. Of those scoring 3/3 at diagnosis, 18/18 [Cambridge] and 12/13 [Uppsala] subsequently developed ASC. Discriminant ability [c-index, where 1.0 = perfect discrimination] was 0.81 [Oxford], 0.95 [Cambridge], 0.97 [Uppsala]. Internal validation using bootstrapping showed good calibration, with similar predicted risk across all cohorts. A nomogram predicted individual risk.
An index applied at diagnosis reliably predicts the risk of ASC within 3 years in different populations. Patients with a score 3/3 at diagnosis may merit early immunomodulator therapy.
急性重症结肠炎（ASC）与严重发病情况相关。我们旨在开发并外部验证一种能在诊断后3年内预测ASC的指标。
开发队列包括年龄在16 - 89岁、在牛津被诊断为溃疡性结肠炎（UC）并随访3年的患者。主要结局是ASC住院情况，排除诊断后1个月内入院的患者。多变量逻辑回归分析了7个风险因素与ASC的校正关联。向后逐步淘汰法得出一个简约模型，该模型经简化后创建了一个易于使用的指标。在来自英国剑桥和瑞典乌普萨拉的独立队列中进行了外部验证。
开发队列（牛津）包括34/111例在中位14个月（范围1 - 29个月）内发生ASC的患者。最终模型对广泛性疾病、诊断时C反应蛋白（CRP）>10mg/l或血红蛋白女性<12g/dl或男性<14g/dl各计1分，得出的分数范围为0/3至3/3。这预测了3年内发生ASC的风险为70%（分数3/3）。验证队列中发生ASC的比例不同（剑桥=25/96；乌普萨拉=18/298）。诊断时得分为3/3的患者中，18/18（剑桥）和12/13（乌普萨拉）随后发生了ASC。判别能力（c指数，1.0表示完美判别）在牛津为0.81，在剑桥为0.95，在乌普萨拉为0.97。使用自助法进行的内部验证显示校准良好，所有队列的预测风险相似。列线图可预测个体风险。
诊断时应用的一种指标能可靠地预测不同人群3年内发生ASC的风险。诊断时得分为3/3的患者可能值得早期免疫调节剂治疗。
