Con Danny, Andrew Bridgette, Nicolaides Steven, van Langenberg Daniel R, Vasudevan Abhinav
Department of Gastroenterology, Eastern Health, Melbourne, Australia.
Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia.
Intest Res. 2022 Jan;20(1):101-113. doi: 10.5217/ir.2020.00146. Epub 2021 Mar 12.
BACKGROUND/AIMS: The residual risk of colectomy after infliximab salvage in steroid-refractory acute severe ulcerative colitis (ASUC) is required to inform the need for subsequent maintenance biologic therapy. The aim of this study was to determine the dynamic response of common serum biomarkers to infliximab salvage and assess their utility in predicting subsequent colectomy.
A retrospective single-center cohort study was conducted on all patients who received infliximab salvage for steroid-refractory ASUC between January 1, 2010, and July 31, 2019. Biomarkers were assessed on admission and days 1 and 3 post infliximab, and included C-reactive protein (CRP)-albumin-ratio (CAR), CRP-lymphocyte-ratio (CLR), platelet-lymphocyte-ratio (PLR) and neutrophil-lymphocyte-ratio (NLR).
Of 94 patients (median age, 35 years; 67% of male), 20% required colectomy at 12 months. Biomarkers on day 3 post-infliximab best differentiated nonresponders, who had higher CRP, lower albumin and lower lymphocyte count (each P< 0.05). Day 3 predictive performance (area under the curve) for 12-month colectomy was best for CAR (0.871) and CLR (0.874), which were similar to Lindgren (0.829; P> 0.05) but superior to Mayo (0.726), partial Mayo (0.719), PLR (0.719), Ho index (0.714), NLR (0.675), Travis score (0.657) and endoscopic Mayo (0.609) (each P< 0.05). A day 3 CAR cutoff of 0.47 mg/g had 79% sensitivity, 80% specificity, 94% negative predictive value (NPV) to predict colectomy; while a day 3 CLR cutoff of 6.0 mg/109 had 84% sensitivity, 84% specificity, 96% NPV.
CAR and CLR measured on day 3 post infliximab salvage for steroid-refractory ASUC represent simple and routinely performed biomarkers that appear to be strong predictors of colectomy. Prospective studies are required to confirm the utility of these predictive scores.
背景/目的：在激素难治性急性重症溃疡性结肠炎（ASUC）中，英夫利昔单抗挽救治疗后结肠切除术的残留风险对于确定后续维持生物治疗的必要性至关重要。本研究的目的是确定常见血清生物标志物对英夫利昔单抗挽救治疗的动态反应，并评估其在预测后续结肠切除术方面的效用。
对2010年1月1日至2019年7月31日期间所有接受英夫利昔单抗挽救治疗的激素难治性ASUC患者进行了一项回顾性单中心队列研究。在入院时以及英夫利昔单抗治疗后的第1天和第3天评估生物标志物，包括C反应蛋白（CRP）-白蛋白比值（CAR）、CRP-淋巴细胞比值（CLR）、血小板-淋巴细胞比值（PLR）和中性粒细胞-淋巴细胞比值（NLR）。
94例患者（中位年龄35岁；67%为男性）中，20%在12个月时需要进行结肠切除术。英夫利昔单抗治疗后第3天的生物标志物最能区分无反应者，无反应者的CRP较高、白蛋白较低且淋巴细胞计数较低（各P < 0.05）。第3天对12个月结肠切除术的预测性能（曲线下面积），CAR（0.871）和CLR（0.874）最佳，与Lindgren评分（0.829；P > 0.05）相似，但优于Mayo评分（0.726）、部分Mayo评分（0.719）、PLR（0.719）、Ho指数（0.714）、NLR（0.675）、Travis评分（0.657）和内镜Mayo评分（0.609）（各P < 0.05）。第3天CAR临界值为0.47 mg/g时，预测结肠切除术的敏感性为79%、特异性为80%、阴性预测值（NPV）为94%；而第3天CLR临界值为6.0 mg/10⁹时，敏感性为84%、特异性为84%、NPV为96%。
对于激素难治性ASUC，英夫利昔单抗挽救治疗后第3天测量的CAR和CLR代表了简单且常规检测的生物标志物，似乎是结肠切除术的有力预测指标。需要进行前瞻性研究以证实这些预测评分的效用。
