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Comparative Study
. 2014 Dec 28;20(48):18367-74.
doi: 10.3748/wjg.v20.i48.18367.

Prognosis of ulcerative colitis differs between patients with complete and partial mucosal healing, which can be predicted from the platelet count

Asuka Nakarai  1 , Jun Kato  1 , Sakiko Hiraoka  1 , Toshihiro Inokuchi  1 , Daisuke Takei  1 , Yuki Moritou  1 , Mitsuhiro Akita  1 , Sakuma Takahashi  1 , Keisuke Hori  1 , Keita Harada  1 , Hiroyuki Okada  1 , Kazuhide Yamamoto  1
Affiliations
Comparative Study

Prognosis of ulcerative colitis differs between patients with complete and partial mucosal healing, which can be predicted from the platelet count

Asuka Nakarai et al. World J Gastroenterol. .

Abstract

Aim: To determine the difference in clinical outcome between ulcerative colitis (UC) patients with Mayo endoscopic subscore (MES) 0 and those with MES 1.

Methods: UC patients with sustained clinical remission of 6 mo or more at the time of colonoscopy were examined for clinical outcomes and the hazard ratios of clinical relapse according to MES. Parameters, including blood tests, to identify predictive factors for MES 0 and slight endoscopic recurrence in clinically stable patients were assessed. Moreover, a receiver operating characteristic curve was generated, and the area under the curve was calculated to indicate the utility of the parameters for the division between complete and partial mucosal healing. All P values were two-sided and considered significant when less than 0.05.

Results: A total of 183 patients with clinical remission were examined. Patients with MES 0 (complete mucosal healing: n = 80, 44%) were much less likely to relapse than those with MES 1 (partial mucosal healing: n = 89, 48%) (P < 0.0001, log-rank test), and the hazard ratio of risk of relapse in patients with MES 1 vs MES 0 was 8.17 (95%CI: 4.19-17.96, P < 0.0001). The platelet count (PLT) < 26 × 10(4)/μL was an independent predictive factor for complete mucosal healing (OR = 4.1, 95%CI: 2.15-7.99). Among patients with MES 0 at the initial colonoscopy, patients of whom colonoscopy findings shifted to MES 1 showed significant increases in PLT compared to those who maintained MES 0 (3.8 × 10(4)/μL vs -0.6 × 10(4)/μL, P < 0.0001).

Conclusion: The relapse rate differed greatly between patients with complete and partial mucosal healing. A shift from complete to partial healing in clinically stable UC patients can be predicted by monitoring PLT.

Keywords: Mayo endoscopic subscore; Mucosal healing; Platelet count; Ulcerative colitis.

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Figures

Figure 1
Figure 1
Kaplan-Meier curves of maintenance of clinical remission for patients with Mayo endoscopic subscore 0, 1 or 2. The cumulative remission maintenance rate showed statistically significant differences among patients with each Mayo endoscopic subscore (MES).
Figure 2
Figure 2
Receiver operating characteristic curve of change in platelet count for identifying the shift from Mayo endoscopic subscore 0 to 1 in patients with clinical remission. The receiver operating characteristic (ROC) curve of change in platelet count for identifying the shift from Mayo endoscopic subscore (MES) 0 to MES 1 had an area under curve of 0.86. When cut-off value of change in platelet count was determined as 1.3 × 104/μL, the sensitivity and specificity were 0.81 and 0.73, respectively.
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References

    1. Head KA, Jurenka JS. Inflammatory bowel disease Part 1: ulcerative colitis--pathophysiology and conventional and alternative treatment options. Altern Med Rev. 2003;8:247–283. - PubMed
    1. Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. Clin Gastroenterol Hepatol. 2007;5:103–110. - PubMed
    1. Pineton de Chambrun G, Peyrin-Biroulet L, Lémann M, Colombel JF. Clinical implications of mucosal healing for the management of IBD. Nat Rev Gastroenterol Hepatol. 2010;7:15–29. - PubMed
    1. Colombel JF, Rutgeerts P, Reinisch W, Esser D, Wang Y, Lang Y, Marano CW, Strauss R, Oddens BJ, Feagan BG, et al. Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology. 2011;141:1194–1201. - PubMed
    1. Ardizzone S, Cassinotti A, Duca P, Mazzali C, Penati C, Manes G, Marmo R, Massari A, Molteni P, Maconi G, et al. Mucosal healing predicts late outcomes after the first course of corticosteroids for newly diagnosed ulcerative colitis. Clin Gastroenterol Hepatol. 2011;9:483–489.e3. - PubMed

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