Departments of Gastroenterology.
Gastrointestinal Surgery.
J Crohns Colitis. 2017 Oct 27;11(11):1309-1316. doi: 10.1093/ecco-jcc/jjx084.
Early objective markers for failure of intravenous[iv] corticosteroid for acute severe colitis [ASC] can avoid delay in rescue therapy or colectomy. We investigated faecal calprotectin [FC], C-reactive protein [CRP], and endoscopy using the ulcerative colitis endoscopic index of severity [UCEIS] as predictors of steroid failure following intensive therapy of ASC.
Consecutive patients with ASC satisfying Truelove and Witts' criteria, hospitalised at a single centre from May 2015 to November 2016, were included; all received iv corticosteroids. The primary outcome measure was steroid failure defined as colectomy and/or rescue therapy with ciclosporin or infliximab during admission. FC levels were measured at admission and on Day 3 of intensive therapy. UCEIS was scored at admission, and CRP on Day 3 of intensive therapy.
Of 49 patients, 21 [43%] failed iv corticosteroids and 15 [31%] underwent surgery. FC levels were significantly higher in steroid failures (2522 [590-9654] µg/g) compared with steroid responders (1530 [352-10278] µg/g) at admission [p = 0.04], as well as on Day 3 of iv corticosteroid therapy (2718 [222-9175] µg/g vs 727 [218-4062] µg/g, p = 0.001). Steroid failures had a higher median [range] UCEIS score than responders (6 [4-8] vs 5 [4-7] [p = 0.001]). CRP level did not differ significantly between steroid failures and responders. A UCEIS > 6 at admission and FC > 1000 µg/g on Day 3 were independent predictors of steroid failure and need for rescue therapy/colectomy.
All patients with UCEIS > 6 and Day 3 FC > 1000 µg/g failed iv corticosteroids. The UCEIS score on admission and Day 3 FC are early predictors of failure of ivcorticosteroid therapy.
急性重度结肠炎（ASC）静脉[iv]皮质类固醇治疗失败的早期客观标志物可避免延误挽救性治疗或结肠切除术。我们研究粪便钙卫蛋白[FC]、C 反应蛋白[CRP]和内镜下溃疡性结肠炎严重指数[UCEIS]作为 ASC 强化治疗后皮质类固醇治疗失败的预测指标。
连续纳入 2015 年 5 月至 2016 年 11 月在单中心住院的符合特鲁洛和威茨标准的 ASC 患者；所有患者均接受 iv 皮质类固醇治疗。主要结局测量指标为住院期间行结肠切除术和/或环孢素或英夫利昔单抗挽救性治疗定义为皮质类固醇治疗失败。入院时和强化治疗第 3 天测量 FC 水平。入院时进行 UCEIS 评分，强化治疗第 3 天检测 CRP。
49 例患者中，21 例（43%）皮质类固醇治疗失败，15 例（31%）行手术治疗。皮质类固醇治疗失败患者的 FC 水平明显高于皮质类固醇治疗反应者（入院时：2522[590-9654]µg/g 比 1530[352-10278]µg/g，p=0.04），以及在 iv 皮质类固醇治疗第 3 天（2718[222-9175]µg/g 比 727[218-4062]µg/g，p=0.001）。皮质类固醇治疗失败患者的 UCEIS 中位数[范围]高于皮质类固醇治疗反应者（6[4-8]比 5[4-7]，p=0.001）。皮质类固醇治疗失败患者和反应者的 CRP 水平无显著差异。入院时 UCEIS＞6 和第 3 天 FC＞1000µg/g 是皮质类固醇治疗失败和需要挽救性治疗/结肠切除术的独立预测因素。
所有 UCEIS＞6 和第 3 天 FC＞1000µg/g 的患者均对 iv 皮质类固醇治疗无反应。入院时的 UCEIS 评分和第 3 天 FC 是 iv 皮质类固醇治疗失败的早期预测指标。
