Department of Gastroenterology, Austin Health, Melbourne, VIC, Australia.
Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, VIC, Australia.
Inflamm Bowel Dis. 2024 Aug 1;30(8):1389-1405. doi: 10.1093/ibd/izad183.
Acute severe ulcerative colitis (ASUC) is a medical emergency for which colectomy is required in patients who do not respond to rescue therapy. While previous studies have predominantly focused on predicting outcome to first-line corticosteroid therapy, there is a need to understand the factors associated with response to rescue therapies in order to improve clinical outcomes. We reviewed the evidence regarding factors associated with response to rescue therapy in adults with ASUC and identified future directions for research.
A systematic search of the literature was conducted, and 2 reviewers independently assessed studies for inclusion.
Of 3509 records screened, 101 completed studies were eligible for inclusion. We identified 42 clinical, hematological, biochemical, endoscopic, or pharmacological factors associated with response to rescue therapy. Older age (≥50 years), thiopurine experience, and cytomegalovirus or Clostridioides difficile infection were associated with a higher risk of nonresponse to rescue therapy. Biochemical factors associated with poorer response included an elevated C-reactive protein (CRP) ≥30mg/L on admission, hypoalbuminemia and an elevated ratio of CRP to albumin. Severe endoscopic findings, including a Mayo endoscopic score of 3 or Ulcerative Colitis Endoscopic Index of Severity ≥5, portended poorer outcomes. The role of fecal calprotectin and therapeutic value of measuring infliximab drug levels in ASUC remain to be defined.
Response to rescue therapy can be predicted by several specific factors, which would aid clinical decision-making. Existing and emerging factors should be integrated within predictive and prognostic models to help improve clinical outcomes.
急性重度溃疡性结肠炎（ASUC）是一种医疗急症，对于那些对挽救性治疗没有反应的患者，需要进行结肠切除术。虽然以前的研究主要集中在预测对一线皮质类固醇治疗的结果上，但需要了解与挽救性治疗反应相关的因素，以改善临床结果。我们回顾了与 ASUC 成人对挽救性治疗反应相关的因素的证据，并确定了未来的研究方向。
对文献进行了系统搜索，两名评审员独立评估研究纳入情况。
在筛选出的 3509 条记录中，有 101 项完成的研究符合纳入标准。我们确定了与挽救性治疗反应相关的 42 个临床、血液学、生化、内镜或药理学因素。年龄较大（≥50 岁）、硫嘌呤经验、巨细胞病毒或艰难梭菌感染与挽救性治疗无反应的风险增加相关。与较差反应相关的生化因素包括入院时 C 反应蛋白（CRP）≥30mg/L、低白蛋白血症和 CRP 与白蛋白的比值升高。严重的内镜表现，包括 Mayo 内镜评分 3 或溃疡性结肠炎内镜严重程度指数≥5，预示着较差的结局。粪便钙卫蛋白的作用和测量英夫利昔单抗药物水平在 ASUC 中的治疗价值仍有待确定。
可以通过几个特定的因素来预测对挽救性治疗的反应，这将有助于临床决策。现有的和新兴的因素应纳入预测和预后模型中，以帮助改善临床结果。
