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Predicting the Individual Risk of Acute Severe Colitis at Diagnosis.

Accepted version
Peer-reviewed

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Article

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Authors

Cesarini, Monica 
Collins, Gary S 
Rönnblom, Anders 
Santos, Antonieta 
Wang, Lai Mun 

Abstract

BACKGROUND AND AIMS: Acute severe colitis [ASC] is associated with major morbidity. We aimed to develop and externally validate an index that predicted ASC within 3 years of diagnosis. METHODS: The development cohort included patients aged 16-89 years, diagnosed with ulcerative colitis [UC] in Oxford and followed for 3 years. Primary outcome was hospitalization for ASC, excluding patients admitted within 1 month of diagnosis. Multivariable logistic regression examined the adjusted association of seven risk factors with ASC. Backwards elimination produced a parsimonious model that was simplified to create an easy-to-use index. External validation occurred in separate cohorts from Cambridge, UK, and Uppsala, Sweden. RESULTS: The development cohort [Oxford] included 34/111 patients who developed ASC within a median 14 months [range 1-29]. The final model applied the sum of 1 point each for extensive disease, C-reactive protein [CRP] > 10mg/l, or haemoglobin < 12g/dl F or < 14g/dl M at diagnosis, to give a score from 0/3 to 3/3. This predicted a 70% risk of developing ASC within 3 years [score 3/3]. Validation cohorts included different proportions with ASC [Cambridge = 25/96; Uppsala = 18/298]. Of those scoring 3/3 at diagnosis, 18/18 [Cambridge] and 12/13 [Uppsala] subsequently developed ASC. Discriminant ability [c-index, where 1.0 = perfect discrimination] was 0.81 [Oxford], 0.95 [Cambridge], 0.97 [Uppsala]. Internal validation using bootstrapping showed good calibration, with similar predicted risk across all cohorts. A nomogram predicted individual risk. CONCLUSIONS: An index applied at diagnosis reliably predicts the risk of ASC within 3 years in different populations. Patients with a score 3/3 at diagnosis may merit early immunomodulator therapy.

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Keywords

Biomarkers, acute severe colitis, clinical trials, prediction, ulcerative colitis, Acute Disease, Adult, Age Factors, C-Reactive Protein, Colitis, Ulcerative, Colonoscopy, Disease Progression, Female, Hemoglobins, Hospitalization, Humans, Male, Middle Aged, Nomograms, Predictive Value of Tests, Risk Factors, Severity of Illness Index, Sex Factors

Journal Title

J Crohns Colitis

Conference Name

Journal ISSN

1873-9946
1876-4479

Volume Title

11

Publisher

Oxford University Press (OUP)