类固醇难治性急性重度溃疡性结肠炎患者术后发病率和死亡率：GETECCU ENEIDA 注册全国多中心研究。
Post-operative morbidity and mortality of a cohort of steroid refractory acute severe ulcerative colitis: Nationwide multicenter study of the GETECCU ENEIDA Registry.
机构信息
Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain. Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, CIBEREHD, Barcelona, Spain. Hospital Reina Sofía, IMIBIC, Cordoba's Univeristy, Cordoba, Spain. Gastroenterology Department, Hospital Universitario de Bellvitge, Barcelona, Spain. Gastroenterology Department, Hospital del Mar, Barcelona, Spain. Gastroenterology Department, Hospital de Cruces, Bilbao, Spain. Gastroenterology Department, Hospital Universitari Mútua Terrassa, CIBEREHD, Barcelona, Spain. Gastroenterology Department, Hospital Lozano Blesa, CIBEREHD, Zaragoza, Spain. Gastroenterology Department, Hospital Puerta de Hierro Majadahonda, Madrid, Spain. Gastroenterology Department, Hospital Universitario de Alicante, CIBEREHD, Alicante, Spain. Gastroenterology Department, Hospital de Sant Pau, Barcelona, Spain. Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, CIBEREHD, Madrid, Spain. Gastroenterology Department, Hospital la Fe, CIBEREHD, Valencia, Spain. Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain. Gastroenterology Department, Hospital de Galdakao, Bilbao, Spain. Gastroenterology Department, Hospital de Basurto, Bilbao, Spain. Gastroenterology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. Gastroenterology Department, Corporació Sanitària Universitària Parc Taulí, CIBEREHD, Barcelona, Spain. Gastroenterology Department, Complejo Hospitalario de Navarra, Navarra, Spain. Gastroenterology Department, Hospital San Jorge, Huesca, Spain. Gastroenterology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain. Gastroenterology Department, Complexo Hospitalario Universitario de Vigo-Instituto de Investigación Biomédica, Pontevedra, Spain. Gastroenterology Department, Consorci Sanitari de Terrassa, Barcelona, Spain. Catalonian Cancer Registry, Oncologist Director Plan of Catalonia, Barcelona, Spain. Cancer Plan of the Catalan Government, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Catalonia, Spain. Cancer Epidemiology, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
出版信息
Am J Gastroenterol. 2018 Jul;113(7):1009-1016. doi: 10.1038/s41395-018-0057-0. Epub 2018 May 1.
BACKGROUND
Despite the increased use of rescue medical therapies for steroid refractory acute severe ulcerative colitis, mortality related to this entity still remains high. We aimed to assess the mortality and morbidity related to colectomy and their predictive factors in steroid refractory acute severe ulcerative colitis, and to evaluate the changes in mortality rates, complications, indications of colectomy, and the use of rescue therapy over time.
METHODS
We performed a multicenter observational study of patients with steroid refractory acute severe ulcerative colitis requiring colectomy, admitted to 23 Spanish hospitals included in the ENEIDA registry (GETECCU) from 1989 to 2014. Independent predictive factors of mortality were assessed by binary logistic regression analysis. Mortality along the study was calculated using the age-standardized rate.
RESULTS
During the study period, 429 patients underwent colectomy, presenting an overall mortality rate of 6.3% (range, 0-30%). The main causes of death were infections and post-operative complications. Independent predictive factors of mortality were: age ≥50 years (OR 23.34; 95% CI: 6.46-84.311; p < 0.0001), undergoing surgery in a secondary care hospital (OR 3.07; 95% CI: 1.01-9.35; p = 0.047), and in an emergency setting (OR 10.47; 95% CI: 1.26-86.55; p = 0.029). Neither the use of rescue medical treatment nor the type of surgical technique used (laparoscopy vs. open laparotomy) influenced mortality. The proportion of patients undergoing surgery in an emergency setting decreased over time (p < 0.0001), whereas the use of rescue medical therapy prior to colectomy progressively increased (p > 0.001).
CONCLUSIONS
The mortality rate related to colectomy in steroid refractory acute severe ulcerative colitis varies greatly among hospitals, reinforcing the need for a continuous audit to achieve quality standards. The increasing use of rescue therapy is not associated with a worse outcome and may contribute to reducing emergency surgical interventions and improve outcomes.
背景
尽管类固醇难治性急性重度溃疡性结肠炎的抢救性医学治疗有所增加，但与该疾病相关的死亡率仍然很高。我们旨在评估类固醇难治性急性重度溃疡性结肠炎中与结肠切除术相关的死亡率和发病率及其预测因素，并评估死亡率、并发症、结肠切除术指征以及随着时间的推移抢救性治疗的使用的变化。
方法
我们对 1989 年至 2014 年期间，23 家西班牙医院纳入 ENEIDA 登记处（GETECCU）的需要结肠切除术的类固醇难治性急性重度溃疡性结肠炎患者进行了一项多中心观察性研究。通过二元逻辑回归分析评估死亡率的独立预测因素。使用年龄标准化率计算研究期间的死亡率。
结果
研究期间，429 例患者接受了结肠切除术，总体死亡率为 6.3%（范围，0-30%）。死亡的主要原因是感染和术后并发症。死亡率的独立预测因素为：年龄≥50 岁（OR 23.34；95%CI：6.46-84.311；p<0.0001）、在二级保健医院进行手术（OR 3.07；95%CI：1.01-9.35；p=0.047）和紧急情况下进行手术（OR 10.47；95%CI：1.26-86.55；p=0.029）。抢救性医疗治疗的使用或所使用的手术技术类型（腹腔镜与开腹手术）均不影响死亡率。在紧急情况下进行手术的患者比例随着时间的推移而下降（p<0.0001），而在结肠切除术前使用抢救性医学治疗的比例逐渐增加（p>0.001）。
结论
类固醇难治性急性重度溃疡性结肠炎的结肠切除术死亡率在不同医院之间差异很大，这强调了需要持续进行审核以达到质量标准。抢救性治疗的使用增加与不良结果无关，并且可能有助于减少紧急手术干预并改善结果。
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