Predictors of disease severity in ulcerative colitis patients from Southwestern Ontario

Abstract

Aim: To understand the demographic characteristics of patients in Southwestern Ontario, Canada with ulcerative colitis (UC) in order to predict disease severity.

Methods: Records from 1996 to 2001 were examined to create a database of UC patients seen in the London Health Sciences Centre South Street Hospital Inflammatory Bowel Disease Clinic. To be included, patients' charts were required to have information of their disease presentation and a minimum of 5 years of follow-up. Charts were reviewed using standardized data collection forms. Disease severity was generated during the chart review process, and non-endoscopic Mayo Score criteria were collected into a composite.

Results: One hundred and two consecutive patients' data were entered into the database. Demographic analyses revealed that 51% of the patients were male, the mean age at diagnosis was 39 years, 13.7% had a first degree relative with inflammatory bowel disease (IBD), 61.8% were nonsmokers and 24.5% were ex-smokers. In 22.5% of patients the disease was limited to the rectum, in 21.6% disease was limited to the sigmoid colon, in 22.5% disease was limited to the left colon, and 32.4% of patients had pancolitis. Standard multiple regression analysis which regressed a composite of physician global assessment of disease severity, average number of bowel movements, and average amount of blood in bowel movements on year of diagnosis and age at time of diagnosis was significant, R(2) = 0.306, F (7, 74) = 4.66, P < 0.01. Delay from symptoms to diagnosis of UC, gender, family history of IBD, smoking status and disease severity at the time of diagnosis did not significantly predict the composite measure.

Conclusion: UC severity is associated with younger age at diagnosis and year of diagnosis in a longitudinal cohort of UC patients, and may identify prognostic UC indicators.

Figure 1

Extent of disease in the ulcerative colitis (UC) patient cohort.

Figure 2

Kaplan Meier curve of colectomy over time.

Figure 3

Indications for colectomy in 15 patients in the UC cohort.

Figure 4

Demographic data on UC patients who underwent colectomy.

Figure 5

Ulcerative colitis disease severity at time of diagnosis and during follow up divided into 3 categories: low severity (modified Mayo Score 0-2), moderate severity (modified Mayo Score 3-5), high severity (modified Maya Score 6-9).