Colectomy risk score predicts pouchitis in patients with ulcerative colitis
Colectomy risk score predicts pouchitis in patients with ulcerative colitis
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DOI：
10.1007/s13304-021-01166-5
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发表时间：
2021-09-07
影响因子：
2.6
通讯作者：
Kitagawa, Yuko
中科院分区：
文献类型：
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作者：
Ikebata, Akiyoshi;Okabayashi, Koji;Kitagawa, Yuko
需要进行风险分层，以改善接受回肠贮袋-肛门吻合术（IPAA）的溃疡性结肠炎（UC）患者的贮袋炎管理。最近，结肠切除术风险评分（CRS）已被用于评估UC的严重程度和预测手术的需要。我们探讨了CRS是否可以预测接受IPAA的UC患者的结肠袋炎。这项回顾性研究包括168例接受IPAA的UC患者。根据结肠袋炎疾病活动指数诊断结肠袋炎。主要终点是结肠袋炎的累积发生率。使用术前获得的数据（包括CRS）研究了结肠袋炎的风险因素。根据他们的CRS，将患者分配到低风险（评分0-3）、中等风险（评分4-6）和高风险（评分7-9）组。使用Kaplan-Meier曲线估计结肠袋炎的发生率。采用考克斯比例风险模型评估CRS有效性。在中位7.2年（四分位距[IQR] 2.8-11.1）的随访期间，37例（28.5%）患者被诊断为结肠袋炎。患有结肠袋炎的患者的CRS显着高于没有结肠袋炎的患者（中位数7.0; IQR，4.0-7.0 vs中位数5.0; IQR，3.0-7.0）。5年时，低、中和高风险组的结肠袋炎累积发生率分别为10.3%、18.3%和36.1%。因此，随着CRS增加，发生率呈显著增加趋势。多变量分析显示，高危CRS状态是结肠袋炎的独立预测因子（风险比：18.03; 95%置信区间1.55-210.05）。CRS可用于对接受IPAA的UC患者进行后续结肠袋炎发生的风险分层。
Risk stratification is required to improve the management of pouchitis with ulcerative colitis (UC) patients who undergo ileal pouch-anal anastomosis (IPAA). Recently, the colectomy risk score (CRS) has been used to assess UC severity and predict the need for surgery. We explored whether the CRS predicted pouchitis in patients with UC who underwent IPAA. This retrospective study included 168 UC patients who underwent IPAA. Pouchitis was diagnosed according to the pouchitis disease activity index. The primary endpoint was the cumulative incidence of pouchitis. The risk factors for pouchitis using preoperatively obtained data, including the CRS, were investigated. Based on their CRS, patients were assigned to low- (scores 0-3), intermediate- (scores 4-6), and high-risk (scores 7-9) groups. The incidence of pouchitis was estimated using the Kaplan-Meier curve. CRS validity was assessed using the Cox proportional hazards model. During the median 7.2 (interquartile range [IQR] 2.8-11.1) years' follow-up, 37 (28.5%) patients were diagnosed with pouchitis. Patients with pouchitis had significantly higher CRS than patients without pouchitis (median 7.0; IQR, 4.0-7.0 vs median 5.0; IQR, 3.0-7.0). The cumulative incidences of pouchitis in the low-, intermediate-, and high-risk groups were 10.3%, 18.3%, and 36.1% at 5 years, respectively. Thus, the incidence trended to increase significantly as CRS increased. Multivariate analysis revealed high-risk CRS status was an independent predictor of pouchitis (hazard ratio: 18.03; 95% confidence interval 1.55-210.05). CRS is useful in risk stratification for the development of subsequent pouchitis in patients with UC undergoing IPAA.