Élaboration d'un score prédictif de la colectomie dans l'année suivant une colite aiguë grave compliquant une rectocolite hémorragique

Abstract : Introduction. Definition criteria of acute severe ulcerative colitis (ASUC) are well established, as well as the treatment strategy after hospital admission. In contrast, there are few data regarding predictors of colectomy at hospital admission. Methods. All consecutive patients with ASUC treated with intravenous treatment and hospitalized in two French hospitals between 2002 and 2017 were included. Patients were followed until occurrence of colectomy or loss of follow-up. Cox survival analysis was performed and the independent risk factors identified by multivariate analysis were used to build a predictive score of colectomy. Results. A total of 270 patients with ASUC were included with a median follow-up of 30 months (interquartile range [IQR] 7 – 6.6) and the cumulative risk of colectomy at one year was 12.3% (IQR: 8.6 – 16.8). By multivariate analysis, previous treatment by anti-TNFs or thiopurines (Hazard ratio (HR): 3.86; CI 95% 1.82-8.18), presence of Clostridium difficile infection (HR: 3.73; CI95% 1.11-12.55), CRP level above 30mg/l (HR: 3.06; CI95% 1.11-8.43), and albumin level below 30 g/l (HR: 2.67; CI95% 1.205.92) were associated with an increased risk of colectomy within one year after admission. Based on a score included these four predictors, the cumulative risk of colectomy within one year was 0,0%, 9.4%, 10.6%, 51,2% and 100% in patients with a score of 0, 1, 2, 3 and 4 items respectively. Conclusion. Four predictors of colectomy within one year were identified. A score combining these predictors was highly predictive of the risk magnitude of colectomy within one year after admission. These findings need to be validated in a replicative cohort.
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Guillaume Le Baut. Élaboration d'un score prédictif de la colectomie dans l'année suivant une colite aiguë grave compliquant une rectocolite hémorragique. Médecine humaine et pathologie. 2018. ⟨dumas-02099934⟩

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