Bourgonje Arno R, Posner Hannah, Carbonnel Franck, Colombel Jean-Frédéric, Kayal Maia
The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
Department of Gastroenterology, University Hospital of Bicêtre, Assistance Publique-Hôpitaux de Paris and Université Paris-Saclay, Le Kremlin Bicêtre, France.
Dig Dis Sci. 2025 Feb;70(2):738-745. doi: 10.1007/s10620-024-08809-8. Epub 2025 Jan 2.
Acute severe ulcerative colitis (ASUC) affects up to 25% of patients with UC and is associated with an increased risk of colectomy. Despite improvements in medical management, individual patient prognostication and risk stratification in ASUC remains challenging. We explored clinical, biochemical, and endoscopic factors as potential predictors for colectomy in patients hospitalized with ASUC.
A retrospective analysis of patients with ASUC as defined by Truelove and Witts criteria admitted to the Mount Sinai Hospital between 2011 and 2020 was conducted. Data on disease history, medication use, clinical symptoms, and laboratory results during admission for ASUC were included. Colectomy risk during hospitalization and within one year was assessed.
We included 158 patients; 34 (21.5%) underwent colectomy during hospital admission and 41 (25.9%) within a year. On multivariable analysis, prior anti-TNF exposure (odds ratio [OR] 4.59, 95% confidence interval [CI] 1.57-13.4, P = 0.005), and biologic use at admission (OR 3.31, 95%CI 1.14-9.63, P = 0.028) were associated with an increased risk of 1-year colectomy. Conversely, mesalamine use at admission decreased this risk (OR 0.31, 95%CI 0.13-0.72, P = 0.006). Other risk factors included recent UC-related hospitalization (< 1 year of admission), higher bowel movement frequency after 3 days of treatment, low hemoglobin and albumin levels, and elevated CRP. Infliximab treatment was associated with decreased risk of urgent (OR 0.30, 95%CI 0.13-0.73, P = 0.007) and 1-year colectomy (OR 0.31, 95%CI 0.14-0.73, P = 0.007).
In patients with ASUC, prior anti-TNF exposure is linked to a higher risk of both short- and long-term colectomy, while recycling infliximab may reduce colectomy risk.
急性重症溃疡性结肠炎（ASUC）影响高达25%的溃疡性结肠炎患者，并与结肠切除术风险增加相关。尽管在药物治疗方面有所改善，但ASUC患者的个体预后和风险分层仍然具有挑战性。我们探讨了临床、生化和内镜因素，作为ASUC住院患者结肠切除术的潜在预测指标。
对2011年至2020年期间入住西奈山医院、符合Truelove和Witts标准定义的ASUC患者进行回顾性分析。纳入了ASUC住院期间的疾病史、用药情况、临床症状和实验室检查结果数据。评估了住院期间和一年内的结肠切除术风险。
我们纳入了158例患者；34例（21.5%）在住院期间接受了结肠切除术，41例（25.9%）在一年内接受了结肠切除术。多变量分析显示，既往抗TNF暴露（比值比[OR]4.59，95%置信区间[CI]1.57 - 13.4，P = 0.005）和入院时使用生物制剂（OR 3.31，95%CI 1.14 - 9.63，P = 0.028）与1年结肠切除术风险增加相关。相反，入院时使用美沙拉嗪可降低此风险（OR 0.31，95%CI 0.13 - 0.72，P = 0.006）。其他风险因素包括近期与UC相关的住院治疗（入院前<1年）、治疗3天后排便频率较高、血红蛋白和白蛋白水平较低以及CRP升高。英夫利昔单抗治疗与紧急结肠切除术风险降低（OR 0.30，95%CI 0.13 - 0.73，P = 0.007）和1年结肠切除术风险降低（OR 0.31，95%CI 0.14 - 0.73，P = 0.007）相关。
在ASUC患者中，既往抗TNF暴露与短期和长期结肠切除术的较高风险相关，而重复使用英夫利昔单抗可能降低结肠切除术风险。
