Department of Gastroenterology & Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
QIMR-Berghofer Medical Research Institute, Brisbane, Australia.
J Crohns Colitis. 2022 Aug 4;16(7):1089-1096. doi: 10.1093/ecco-jcc/jjac014.
The erythrocyte sedimentation rate [ESR] as a component of the Truelove and Witts Criteria [TWC] is the traditional inflammatory marker used for the assessment of ulcerative colitis [UC] activity. However, the C-reactive protein [CRP] is preferentially used in contemporary clinical practice. We aimed to determine the equivalent CRP cut-off for an ESR of >30 mm/h in patients presenting with acute severe UC.
Clinical and pathological data were prospectively collected from 163 presentations of severe UC. A CRP cut-off corresponding to an ESR of >30 mm/h was determined using confusion matrices. A validation cohort of 128 presentations was prospectively collected and analysed.
A CRP cut-off of ≥12 mg/L generated an 85% positive predictive value [PPV] with a sensitivity of 95% and an accuracy of 82% for having a paired ESR of >30 mm/h. There were no statistically significant differences between groups determined by the traditional ESR versus the new CRP-based criterion in the presenting faecal calprotectin, Mayo endoscopic subscore, or the rates of intravenous corticosteroid therapy failure and colectomy-by-discharge. Applying the CRP ≥12 mg/L criterion to a validation cohort of 128 presentations generated a PPV of 83% and a sensitivity of 94%.
The proposed CRP ≥12 mg/L cut-off is an inclusive, sensitive, and very practical alternative to ESR as part of the TWC for defining UC presentation severity. It demonstrated similar performance characteristics to the classical ESR criterion when used for the assessment of acute UC disease activity. These findings were confirmed in a validation cohort.
红细胞沉降率（ESR）作为特鲁洛夫和威茨标准（TWC）的组成部分，是用于评估溃疡性结肠炎（UC）活动的传统炎症标志物。然而，C 反应蛋白（CRP）在当代临床实践中更优先使用。我们旨在确定在出现急性重度 UC 的患者中，ESR ＞30mm/h 对应的 CRP 截断值。
前瞻性收集了 163 例重度 UC 患者的临床和病理数据。使用混淆矩阵确定与 ESR ＞30mm/h 相对应的 CRP 截断值。前瞻性收集并分析了 128 例就诊患者的验证队列。
CRP 截断值≥12mg/L 对 ESR ＞30mm/h 具有 85%的阳性预测值（PPV），敏感性为 95%，准确性为 82%。根据传统 ESR 与新的基于 CRP 的标准确定的两组之间，在就诊时粪便钙卫蛋白、Mayo 内镜评分亚量表或静脉皮质类固醇治疗失败和出院时结肠切除的发生率方面，无统计学差异。在 128 例就诊患者的验证队列中应用 CRP≥12mg/L 标准，PPV 为 83%，敏感性为 94%。
所提出的 CRP≥12mg/L 截断值是一种包容性、敏感性和非常实用的替代 ESR 的方法，可作为 TWC 定义 UC 表现严重程度的一部分。当用于评估急性 UC 疾病活动时，它表现出与经典 ESR 标准相似的性能特征。这些发现在验证队列中得到了证实。
