Medical treatment selection and outcomes for hospitalized patients with severe ulcerative colitis as defined by the Japanese criteria

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发表日期：

2024年1月26日

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Makoto Naganuma,
Naohiro Nakamura,
Reiko Kunisaki,
Katsuyoshi Matsuoka,
Shojiro Yamamoto,
Ami Kawamoto,
Daisuke Saito,
Taku Kobayashi,
Kosaku Nanki,
Kazuyuki Narimatsu,
Hisashi Shiga,
Motohiro Esaki,
Shinichiro Yoshioka,
Shingo Kato,
Masayuki Saruta,
Shinji Tanaka,
Eriko Yasutomi,
Kaoru Yokoyama,
Kei Moriya,
Yoshikazu Tsuzuki,
Makoto Ooi,
Mikihiro Fujiya,
Atsushi Nakazawa,
Tomohisa Takagi,
Teppei Omori,
Toshiyuki Tahara,
Tadakazu Hisamatsu,
Reiko Kunisaki,
Shojiro Yamamoto,
Souichiro Ogawa,
Hotaka Tamura,
Keisuke Uchida,
Toshiro Fukui,
Norimasa Fukata,
Naohiro Nakamura,
Yasuki Sano,
Yusuke Honzawa,
Katsuyoshi Matsuoka,
Ami Kawamoto,
Masakazu Nagahori,
Ryuichi Okamoto,
Daisuke Saito,
Miki Miura,
Tadakazu Hisamatsu,
Kosaku Nanki,
Yusuke Yoshimatsu,
Kazuyuki Narimatsu,
Ryota Hokari,
Hisashi Shiga,
Yoichi Kakuta,
Tomohiro Fukuda,
Aya Hojyo,
Shintaro Sagami,
Taku Kobayashi,
Toshufumi Hibi,
Yasuhisa Sakata,
Motohiro Esaki,
Shinichiro Yoshioka,
Kozo Tsuruta,
Masaru Morita,
Keiichi Mitsuyama,
Shingo Kato,
Naoki Shibuya,
Ryosuke Miyazaki,
Masayuki Saruta,
Ryohei Hayashi,
Shinji Tanaka,
Eriko Yasutomi,
Sakiko Hiraoka,
Kaoru Yokoyama,
Kiyonori Kobayashi,
Mariko Kajiwara,
Tomohisa Takagi,
Kei Moriya,
Yoshikazu Tsuzuki,
Hiroyuki Imaeda,
Eri Tokunaga,
Mitsuru Ooi,
Nobuhiro Ueno,
Mikihiro Fujiya,
Toshiyuki Tahara,
Ayumu Yokoyama,
Atsushi Nakazawa,
Shun Murasugi,
Tomoko Kuriyama,
Teppei Omori,
Ken Takeuchi,
Shinichi Hashimoto,
Daisuke Hirayama,
Tomoe Kazama,
Hiroshi Nakase,
Takako Miyazaki,
Shiro Nakamura,
Akihiko Oka,
Kousaku Kawashima,
Shunji Ishihara,
Shunichi Yanai,
Takayuki Matsumoto,
Toshiyuki Sato,
Yoko Yokoyama,
Kenji Watanabe,
Yasunori Yamamoto,
Yoichi Hiasa,
Hideki Bamba,
Akira Ando,
Yuki Ohta,
Kengo Kanayama,
Jun Kato,
Naoki Omiya,
Sohachi Nanjyo

摘要

Background

Hospitalization for ulcerative colitis (UC) is potentially life-threatening. Severe disease in the Japanese criteria which modifies the Truelove–Witts’ criteria might encompass more fulminant cases than the definition for acute severe UC. However, few studies have investigated the predictive factors for clinical remission (CR) after medical treatments for severe hospitalized patients by Japanese criteria.

Methods

Medical treatment selection, CR rates, and factors contributing to CR on day 14 were assessed in severe patients by Japanese criteria. We also investigated whether the reduction rate in patient-reported outcome 2 (PRO2) on day 3 could predict short-term prognosis.

Results

Eighty-five severe hospitalized patients were selected. Corticosteroids, tacrolimus, and infliximab were mainly selected as first-line treatments (76/85; 89.4%). The CR rates on day 14 were 26.8%, 21.4%, and 33.3% in patients receiving corticosteroids, tacrolimus, and infliximab, respectively. Extensive disease (odds ratio [OR] 0.022; 95% confidence interval [CI] 0.002–0.198), higher PRO2 (OR 0.306; 95% CI 0.144–0.821), and higher reduction rate in PRO2 on day 3 (OR 1.047; 95% CI 1.019–1.075) were independent factors predicting CR on day 14. If the cutoff value for the reduction rate in PRO2 on day 3 was 18.3%, sensitivity was 0.714 and specificity was 0.731 to predict CR on day 14. A higher reduction rate in PRO2 on day 3 (OR 0.922; 95% CI 0.853–0.995) was a negative factor to predict surgery within 28 days.

Conclusions

Tacrolimus and infliximab in addition to corticosteroids were used as first-line treatment in severe hospitalized patients. PRO2 on day 3 is a useful marker for switching to second-line therapy or colectomy.