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, Annexe, vol.2

, Annexe 7 : Cellules à inclusion virales, te?moin d'un effet cyto-pathogène du CMV, vol.65

, Les caractéristiques cliniques, biologiques, radiologiques et endoscopiques sont re?gulièrement associe?es au risque d'e?chec des corticoïdes : -L'e?chec de la corticothe?rapie orale e?tait un facteur de risque d'e?chec de la corticothérapie intraveineuse dans 2 études

. -l'activite?deactivite?de-la-maladie-À-l'admission and . De-truelove, et 64% d'e?chec si critères de Truelove présents vs 32% [77]), le score de Lichtiger (15 dans le groupe échec vs 13, vol.1, pp.5-9

, Un nombre de selle important par jour à l'entre?e était un facteur de risque dans 3

, 86% de non réponse si entre 9 et 12 selles (versus 49% si moins de 9 selles) (p < 0,001) [78]), 49% de réponse si plus de 12 selles par jour, versus 60% si entre 9 et 11 selles par jour, et 64% si 6-8 selles par jours, vol.1

, La présence de sang dans les selles était significative à J3 dans 2 e?tudes (93% en cas d'e?chec vs 35%

, Dans une population pédiatrique, avoir plus de 2 selles nocturnes au 3 ème jour (OR = 3.2, IC95% 1.6 to 6.6) était un facteur de risque en multivariée, vol.82

, Le nombre de selles par 24h à J3 (>8 : OR = 4,2) et la quantité de sang dans les selles (OR = 3,5 si abondant) étaient associés en uni-variés mais pas en multivariés, vol.82

, -D'autres facteurs cliniques semblent beaucoup plus discordants : la température à l'entre?e e?tait NS dans 6 e?tudes, vol.17, pp.79-81

, La fréquence cardiaque à l'entre?e n'e?tait pas associée dans 4 études, vol.17

, La douleur abdominale était significative dans une étude (71% vs 40%, vol.79

, Les données sont discordantes à propos de l'albumine?mie, le taux sérique de la CRP et l'he?moglobine?mie : le taux sérique de la CRP était NS dans 7 études, vol.95, pp.79-81

, Dans l'e?tude pe?diatrique, le taux sérique de la CRP à J3 e?tait e?galement pre?dictive du risque de d'e?chec de la corticothérapie (OR = 2.4, IC95% 1.01 to 5.8, p = 0.049), tout comme le taux sérique de la CRP à J5, Concernant l'albumine?mie, elle n'e?tait pas associe?e dans 7 e?tudes, vol.30, pp.81-83

, L'he?moglobine était NS dans 6 études, vol.77, pp.79-82

, g/dL : OR =, vol.8, p.45

M. T. -la-pre?sence-d&apos;un, tout comme la pre?sence de gaz dans l'intestin grêle (67% dans le groupe e?chec vs 15%, p = 0,05) et d'un niveau air -liquide (100% vs 54, p = l'e?chec des corticoïdes IV : 72% de lésions sévères échec vs 40% [77], comme la perte de la muqueuse à l'endoscopie (35% vs 6%, 70% d'e?chec vs 22%

, Concernant la rapidité de réponse à la corticothérapie, elle était plus rapide (dans les 10 premiers jours vs après 10 jours) en cas d'âge à l'admission plus faible (33 ans vs 53 ans, p.0

, Lors d'une pancolite, la re?ponse à la corticothe?rapie serait plus longue que lors d

, La présence de lésions polypoïdes serait également associée à une réponse plus lente (28,2 jours +/-6

, Aucun critère endoscopique et radiologique pre?dictif de la rapidite?derapidite?de la re?ponse n'a cependant e?te?mis e?te?mis en évidence dans une étude plus récente, vol.78

, Enfin, la re?ponse aux corticoïdes n'e?tait pas influence?e par la prescription de thiopurines durant l'hospitalisation, vol.79

M. Truelove, Lichtiger), la pre?sence d'un MT ou de le?sions se?vères en endoscopie, et l'e?chec des corticoïdes PO avant la pousse?e semblent être associe?s à l'e?chec des corticoïdes IV. Certains facteurs comme le sexe, le tabac, l'extension de la maladie, Au total, les scores de gravités

, Concernant les facteurs cliniques associés, un âge jeune était significativement associé dans une étude (30ans vs 40ans pour les non répondeurs, vol.008, p.0

, Le tabagisme actif était associé à une moins bonne réponse dans la seule étude ayant analysé ce paramètre, vol.91

, Une maladie e?tendue e?tait pre?dictive d'une bonne re?ponse en univarie?e (9/11 vs 1/11, p = 0,04)

, Concernant les facteurs cliniques, une réponse initiale était plus fréquente en cas de fréquence cardiaque basse (91/min vs 105/min en cas de colectomie précoce

, Il en était de même pour la réponse soutenue (88 /min vs 98 /min, p.41

. Cependant,

, Une température non augmentée était associée à une réponse soutenue à long terme

, Le nombre de selles par jour [109,110] n'e?tait pas pre?dictif de la réponse

, Une réponse soutenue à la ciclosporine était également plus souvent obtenue en cas de globules blancs bas (11,1 /mm 3 vs 13,9 /mm 3 toutes colectomies confondues, Concernant les facteurs biologiques, l'albumine?mie n'e?tait pas prédictive de la réponse dans 3 études, vol.04, p.0

, 9000 en cas de réponses soutenue, 22 000 en cas de colectomie, Mais le seul facteur associé à une réponse précoce et soutenue en multivarié était le nombre de polynucléaires (13 000 en cas de réponses initiales, p.472

, Les lésions endoscopiques ne sont également pas prédictives de la réponse, vol.110

. Enfin, la dose de la ciclosporine et la ciclosporinémie, vol.110

, Facteurs pre?dictifs de re?ponse à l'infliximab lors d'une CAG Le sexe, l'extension de la maladie et le statut tabagique n'e?tait pas associe?s à la réponse dans les 2 études, Annexe, vol.10

, Dans la 1 ère e?tude, l'âge au moment de la poussée, le nombre de poussée antérieure, la durée de la maladie, un traitement antérieur par 5-ASA ou thiopurine, un score de lichtiger élevé, une longue durée entre le début des corticoïdes et de la ciclosporine ou entre la ciclosporine et l'infliximab n

, Dans la 2 ème étude, le nombre de selles, le taux sérique de la CRP, la calprotectine fe?cale, l'âge au diagnostic, à l'admission et à J3 n'e?taient également pas prédictifs de la réponse

, Dans le cas particulier des CAG chez l'enfant, ce qui ne correspond pas à notre population d'e?tude, les facteurs pre?dictifs d'absence de re?ponse à l'infliximab était la durée de la maladie (0,5 mois chez les non répondeurs vs 5,4 mois, p = 0,015), une maladie plus active selon le score de PUCAI à l'admission

, Annexe 11 : Proposition d'algorithme de prise en charge des CAG cortico-résistante

, Cet arbre a le me?rite d'exister mais il semble difficilement applicable dans l'imme?diat : il a e?te?cre?e?àe?te?cre?e?e?te?cre?e?à partir d'un faible nombre de malades, avec des différences significatives sur le tabac, ou le score mayo

, De plus, dans cet arbre, la ciclosporine serait possible en cas de patients de?jà expose?s à l'azathioprine, entraînant, un sur-risque de colectomie, vol.102

, Cette étude était donc très intéressante dans sa construction, mais ses facteurs doivent être confirme?s dans d'autres e?tudes pour choisir avec plus de certitudes entre ces 2 traitements

, Traitement chirurgical au cours de la RCH : Colectomie subtotale, vol.12

, Anastomose iléo -anale, vol.245

, Facteurs pre?dictifs de colectomie durant ou à la suite d'une CAG, Annexe, vol.13

, Lorsqu'il n'y a pas de pre?cision sur la date de recueil de la variable, il s'agit par de?faut du de?but de l'hospitalisation. Lorsqu'il s'agit d'un jour particulier en rapport avec le de?but d'un traitement de 2 nd ligne, celui-ci est précisé. Aucune caractéristique liée au terrain ne semble associée de manière évidente au risque de colectomie : -Un âge élevé au diagnostic était un facteur protecteur dans 1 étude, Les facteurs pre?dictifs de colectomie durant ou à la suite d'une CAG sont de?taille?es par la suite, vol.89, pp.46-65

, Par ailleurs, l'âge à l'admission n'e?tait pas associe?dansassocie?dans 11 e?tudes, vol.24

, 166]), dans 2 études où les patients recevaient de la ciclosporine en traitement de sauvetage (âge > 50 ans : OR = 1,08, Cependant, ce facteur était faiblement associé à la colectomie dans 7 études : dans 2 études sans traitement médical de 2 nd ligne (OR = 1,09, IC95% 1, vol.16, p.0

, Être une femme était un facteur protecteur dans 2 études (OR = 0, vol.37, p.95

, 44% de patients non opérés étaient des femmes vs, vol.99, p.5

, -Le tabagisme était non associé à la chirurgie dans 10 études

, Aucune origine ethnique n'e?tait associe?e à la colectomie dans une e?tude africaine

, Ce facteur était cependant NS dans 3 études, p.55

, MV[186]) (que ce soit durant l'hospitalisation ou à plus long terme

, et dans le même sens, une maladie étendue était un facteur de risque dans 2 études (OR 5,5; IC95% 1,57-19,01, [108]), dont une spécifique de la ciclosporine (27% de colectomie à 3 mois en cas de maladie e?tendue vs 13% en cas d'atteinte du côlon gauche, Concernant les études ayant précisées le traitement médical de 2 nd ligne, une maladie peu étendue était associée à une absence de colectomie dans 1 étude (OR = 0, vol.35, p.0

. De, 31% si 2 critères présents, et 48% si 3 critères ou plus) [15]. A l'inverse, le nombre de critères en plus de la pre?sence de selles sanglantes n

M. Le-score,

, 008) [194], tout comme une maladie dite « sévère » (31% des patients non opérés vs 87,5% des patients opérés, p < 0,01, [128]) et un score de Lichtiger élevé au de?but d'un traitement me?dical de 2 nd ligne (14,1 en cas colectomie vs 11,5 en absence de colectomie, p = 0,003) [73]). Le score de Lichtiger à l'initiation de la ciclosporine n, vol.3

, ou la présence de lésions sévères [39]). A l'inverse du score mayo endoscopique, l'UCEIS était significatif dans une étude chinoise (UCEIS médian de 4,49 en absence de colectomie, versus 6,24 dans le groupe colectomie, -Les caracte?ristiques endoscopiques n'e?taient pas associe?es dans 3 e?tudes, vol.001, p.0

, A propos des facteurs biologiques, certains sont fréquemment associés dans les études : -Tout d'abord, le taux sérique de la CRP était NS dans 8 études, vol.39

, Si la CRP est évaluée à J3, le risque de colectomie est plus important, vol.36, p.3

, Dans le même sens, un taux sérique de la CRP augmenté au début du traitement médical de 2 nd ligne était un facteur de risque dans 3 études, Un taux sérique de CRP > 45 mg/L au début de la ciclosporine était également prédictive de colectomie (HR = 1,70, IC95% 1, vol.16, pp.34-36

. -l&apos;albumine?mie, La malnutrition au cours de l'hospitalisation e?tait e?galement un facteur de risque de colectomie dans une autre étude (OR = 6, Une hypoalbuminémie au de?but de l'infliximab, vol.13, pp.64-72

, Un taux d'albumine?mie inférieur à 27 g/L était associé en univariée, vol.84, pp.75-75

A. Traitement-de-sauvetage, ce facteur de risque était également mis en évidence (36 g/L d'abumine?mie dans le groupe non -opéré vs 31 g/L dans le groupe opéré

, -L'he?moglobine?mie à l'entre?e e?tait NS dans 13 e?tudes, vol.24, pp.195-197

, Une he?matocrite infe?rieure à 36% à l'admission e?tait un facteur de risque dans une étude (OR = 3,03, IC95% 1, vol.79, pp.59-64

-. Blancs,

, -Le taux de plaquettes était significatif dans une étude

, -La dilatation colique à l'introduction de la ciclosporine n'e?tait pas significative dans 2 études, vol.73

, Annexe, vol.18

, A) Multivariate feature selection for prediction of colectomy in follow-up using the Boruta algorithm

, B) Multivariate feature selection for prediction of steroid dependence in follow-up using the Boruta algorithm

, Score des comorbidités de Charlson, vol.19

, Patients ayant une CAG selon le score de Lichtiger ou les critères de Truelove. Pts : patients, Pt : patient, Hb : hémoglobine, T°C : Température en degré Celsius, FC : Fréquence cardiaque, vol.22