F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Dig Dis Sci. 2021 Jan;66(1):199-205. doi: 10.1007/s10620-020-06177-7. Epub 2020 Mar 13.
Infliximab rescue therapy is effective in patients with corticosteroid refractory acute severe ulcerative colitis, but predictors of response remain poorly understood. We aimed to identify predictors of colectomy in this high-risk patient population.
Patients hospitalized with acute severe ulcerative colitis who received infliximab after failing intravenous corticosteroid therapy between July 2012 and June 2017 were retrospectively identified. Stepwise regression with backward elimination was used to identify predictors of colectomy at 90 days and 1 year. Ninety-day and 1-year colectomy rates were compared between the patients who received 5 mg/kg and 10 mg/kg IFX rescue dose.
Sixty-three patients met the eligibility criteria. Twenty-nine patients received 5 mg/kg, and 34 received 10 mg/kg infliximab dose. Serum albumin on admission (OR 0.10; p = 0.04) and band neutrophil percentage at the time of infliximab administration (OR 1.21; p = 0.02) were independent predictors of 90-day colectomy. A combination of serum albumin ≤ 2.5 g/dl and band neutrophil count ≥ 13% had a 100% positive predictive value for 90-day colectomy. Unadjusted 90-day and 1-year colectomy rates were similar in the 5 mg/kg and 10 mg/kg infliximab groups. After adjusting for confounding factors, 10 mg/kg infliximab dose was potentially protective for 90-day (OR 0.07; p = 0.06) but not for 1-year colectomy (OR 0.19; p = 0.16).
Bandemia and low serum albumin are independent predictors of failure of infliximab rescue therapy in acute severe ulcerative colitis. Serum albumin ≤ 2.5 g/dl and band neutrophil count ≥ 13% had a 100% positive predictive value for 90-day colectomy.
英夫利昔单抗（Infliximab）解救疗法对皮质类固醇难治性急性重度溃疡性结肠炎患者有效，但反应的预测因素仍知之甚少。我们旨在确定该高危人群中结肠切除术的预测因素。
回顾性确定 2012 年 7 月至 2017 年 6 月期间因静脉内皮质类固醇治疗失败而接受英夫利昔单抗治疗的急性重度溃疡性结肠炎住院患者。采用逐步回归法进行向后消除，以确定 90 天和 1 年时结肠切除术的预测因素。比较接受 5mg/kg 和 10mg/kg IFX 解救剂量的患者的 90 天和 1 年结肠切除术率。
符合条件的患者有 63 名。29 名患者接受 5mg/kg，34 名患者接受 10mg/kg 英夫利昔单抗剂量。入院时血清白蛋白（OR 0.10；p=0.04）和英夫利昔单抗给药时带中性粒细胞百分比（OR 1.21；p=0.02）是 90 天结肠切除术的独立预测因素。血清白蛋白≤2.5g/dl 和带中性粒细胞计数≥13%的组合对 90 天结肠切除术有 100%的阳性预测值。5mg/kg 和 10mg/kg 英夫利昔单抗组未校正的 90 天和 1 年结肠切除术率相似。在校正混杂因素后，10mg/kg 英夫利昔单抗剂量对 90 天结肠切除术有潜在保护作用（OR 0.07；p=0.06），但对 1 年结肠切除术无保护作用（OR 0.19；p=0.16）。
带血中性粒细胞和低血清白蛋白是急性重度溃疡性结肠炎英夫利昔单抗解救治疗失败的独立预测因素。血清白蛋白≤2.5g/dl 和带中性粒细胞计数≥13%对 90 天结肠切除术有 100%的阳性预测值。
