Correlation between the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and intestinal mucosal calprotectin in acute severe ulcerative colitis.

Chamoun, J. (Jouli) (2014) Correlation between the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and intestinal mucosal calprotectin in acute severe ulcerative colitis. thesis, Medicine.

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Abstract

Background: Around 30 % of patients hospitalized for acute ulcerative colitis will not respond to the conventional therapy with steroids. These patients will need rescue therapy with either infliximab or cyclosporin and/or may even need a colectomy. Identifying patients who need these treatments after steroid failure in an early phase will reduce morbidity. Predicting the outcome of acute severe colitis (ASC) with endoscopic information has been examined using the Ulcerative Colitis Endoscopic index of Severity (UCEIS). This index seems to predict a worse outcome; higher scores are found in patients failing steroid treatment and a high index score predicts the need for rescue therapy. The UCEIS therefore may indicate a threshold for an early decision to use rescue therapy. This index however has yet to be correlated with calprotectin, a protein that plays a pivotal role in the intestinal inflammation process, and intestinal mucosal calprotectin (IMC) itself has yet to be examined as a predictor of the outcome of ASC. Goal: To examine whether intestinal mucosal calprotectin correlates with the UCEIS and whether it can predict the outcome in our ASC cohort. Methods: We retrospectively examined a cohort of 70 cases of ASC, admitted to the John Radcliffe Hospital between July 2010 and November 2012. We reviewed a database of collected data such as clinical parameters and UCEIS score on admission, inpatient management, response to therapy and outcome (defined as need for rescue therapy or colectomy). We examined archived biopsies taken during admission of 52 patients; sections were cut and stained for calprotectin using immunohistochemistry. After this, mean numbers of calprotectin positive cells per high power field (hpf) (20X) were determined and used in the statistical analysis. The predictive potential of IMC together with other possible predictors of outcome were analyzed using multivariate logistic regression. The correlation between the UCEIS and mucosal calprotectin was analyzed using Student’s t-tests and ranksum Mann-Whitney tests. Results: The mean (± SD) IMC value of 52 patients was 202,3 ± 112,2 positive cells/hpf with a range between 1,2 cells and 539,6 positive cells/hpf. The UCEIS score was grouped into three groups. No significant difference in mean IMC value was found between the three UCEIS groups (P values were 0,07 , 0,71 , 0,24). When analyzing the outcome of our cohort, none of the possible predictors, including calprotectin (P=0,10), seemed to predict the need for colectomy. However, IMC value did appear to be a reasonable predictor for the need for rescue therapy (P=0,03) with an odds ratio of 1,01. Our study showed that for every increase of IMC value of 50 positive cells, the odds of needing rescue therapy appears to be 1,54. At multivariate analysis, a model that significantly predicts the need for rescue therapy includes the IMC value, the UCEIS score and age as predictors (P=0,02 , P=0,03 , P=0,01). Conclusion: Our study shows that IMC does not correlate with the UCEIS score in our cohort. Intestinal mucosal calprotectin is a predictor of disease outcome in patients with ASC. It did not predict colectomy in our study, but does however seem to predict the need for rescue therapy; an increase in calprotectin-positive cells in inflamed colonic mucosa is associated with an increased likelihood of needing rescue therapy. Although analysis of our small retrospective cohort showed no correlation between the UCEIS and IMC, further analyzing this possible correlation has more potential when performing a prospective study with a larger ASC cohort.

Item Type:	Thesis (Thesis)
Supervisor name:	Dijkstra, Prof. Dr.G. and Department of Gastroenterology and Hepatology and UMCG
Supervisor name:	Keshav, Dr. S. and Travis, Dr. S. and Gastroenterology Unit and John Radcliffe Hospital
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:58
Last Modified:	25 Jun 2020 10:58
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1811

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