Predicting the Individual Risk of Acute Severe Colitis at Diagnosis

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Predicting the Individual Risk of Acute Severe Colitis at Diagnosis

Cesarini, Monica (author): Oxford Univ Hosp, Translat Gastroenterol Unit, Oxford, England.;Sapienza Univ Rome, Dipartimento Med Interna & Specialita Med, Rome, Italy.

Collins, Gary S. (author): Univ Oxford, Ctr Stat Med, Oxford, England.

Rönnblom, Anders (author): Uppsala universitet,Gastroenterologi/hepatologi

Santos, Antonieta (author): Cambridge Univ Hosp, Gastroenterol Unit, Cambridge, England.;Hosp Amato Lusitano, Gastroenterol Unit, Castelo Branco, Portugal.

Wang, Lai Mun (author): Oxford Univ Hosp, Dept Cellular Pathol, Oxford, England.

Sjöberg, Daniel, 1974- (author): Uppsala universitet,Gastroenterologi/hepatologi

Parkes, Miles (author): Oxford Univ Hosp, Translat Gastroenterol Unit, Oxford, England.

Keshav, Satish (author): Oxford Univ Hosp, Translat Gastroenterol Unit, Oxford, England.

Travis, Simon P. L. (author): Oxford Univ Hosp, Translat Gastroenterol Unit, Oxford, England.

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Oxford Univ Hosp, Translat Gastroenterol Unit, Oxford, England;Sapienza Univ Rome, Dipartimento Med Interna & Specialita Med, Rome, Italy. Univ Oxford, Ctr Stat Med, Oxford, England. (creator_code:org_t)

2016-09-19
2017
English.
In: Journal of Crohn's & Colitis. - : OXFORD UNIV PRESS. - 1873-9946 .- 1876-4479. ; 11:3, s. 335-341

Related links:: https://academic.oup...; show more...; https://urn.kb.se/re...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

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] >10 mg/l, or haemoglobin < 12 g/dl F or < 14 g/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.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Gastroenterologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)

Keyword

Biomarkers
clinical trials
acute severe colitis
prediction
ulcerative colitis

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ref (subject category)
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By the author/editor: Cesarini, Monica; Collins, Gary S.; Rönnblom, Anders; Santos, Antoniet ...; Wang, Lai Mun; Sjöberg, Daniel, ...; show more...; Parkes, Miles; Keshav, Satish; Travis, Simon P. ...; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Gastroenterology ...

Articles in the publication: Journal of Crohn ...

By the university: Uppsala University

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