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Master Thesis

Performances diagnostiques de la CRP, de l'albuminémie, de l'endoscopie et du scanner dans l'évaluation des ulcérations creusantes au cours de la rectocolite hémorragique

Abstract : Introduction: deep ulcerations (DU) in ulcerative colitis (UC) is a commonly used severity criterion. The aim of this study was to evaluate the diagnostic performances of C-reactive protein (CRP), albuminemia, endoscopy and computed tomography (CT) to identify DU. Methods: in this retrospective study we included consecutively every patient who had a colectomy due to UC in Bordeaux University Hospital Center between January 2012 and February 2019. All operative specimens were studied by two different pathologists. Thus, patients were classified in two different groups: DU+ when they had histological colonic DU or rectal DU during a colonoscopy; DU- when they had no DU. We used electronic medical records to assess patients clinical, biochemical, endoscopic and CT data. Results: forty-nine patients who had colectomy were included: 41 had acute severe ulcerative colitis, 6 had treatment-refractory disease and 2 had dysplasia or colorectal cancer. There were 28 patients in DU+ group and 21 patients in DU- group. CRP was significantly higher when patients had DU (98.9 [IQR: 42.4; 155.3] mg/l) than when they did not (17.5 [IQR: 5.2; 53.5] mg/l) (p<0.001). When CRP was over 100 mg/l its specificity and positive predictive value (PPV) to detect DU were 100 %. Albuminemia was significantly lower when patients had DU (26.3 [IQR: 23.6; 30.7] g/l) than when they did not (30.9 [IQR: 28.1; 35.2] g/l) (p=0.009). When albuminemia was under 26 g/l its specificity and PPV were 89 % and 86 %. When CRP/albuminemia ratio was higher than 2.5, it had a sensitivity of 59 %, a specificity of 89 %, a PPV of 89 %. Sensitivity, specificity, PPV and NPV of endoscopy to identify colonic DU were 74 %, 75 %, 77 % and 71 %. Conclusion: CRP and albuminemia are the most accurate tests to identify DU in UC, especially when CRP is over 100 mg/l. If we could confirm those results in a prospective cohort, some hospitalized patients for UC could avoid colonoscopy to identify DU.
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Anne Le Chevillier. Performances diagnostiques de la CRP, de l'albuminémie, de l'endoscopie et du scanner dans l'évaluation des ulcérations creusantes au cours de la rectocolite hémorragique. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02492712⟩

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