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. 2021 Jun 14;27(22):3109-3120.
doi: 10.3748/wjg.v27.i22.3109.

Early serum albumin changes in patients with ulcerative colitis treated with tacrolimus will predict clinical outcome

Natsuki Ishida  1 , Takahiro Miyazu  1 , Satoshi Tamura  1 , Shinya Tani  1 , Mihoko Yamade  1 , Moriya Iwaizumi  2 , Yasushi Hamaya  1 , Satoshi Osawa  3 , Takahisa Furuta  4 , Ken Sugimoto  5
Affiliations

Early serum albumin changes in patients with ulcerative colitis treated with tacrolimus will predict clinical outcome

Natsuki Ishida et al. World J Gastroenterol. .

Abstract

Background: Oral tacrolimus is a therapeutic agent for moderate to severe steroid-dependent or resistant ulcerative colitis (UC), but remission induction is difficult, and it is necessary to treat the patient while considering the next treatment.

Aim: To examine serum albumin (Alb) level as a prognostic factor for the therapeutic effect of tacrolimus in clinical practice.

Methods: Forty-seven patients with UC treated with tacrolimus at our institution were divided into remission and failure groups (colectomy or switch to biologics), and the biological data at the start of observation and at weeks 1 and 2 were retrospectively examined. Kaplan-Meier and multivariate analyses were performed using Alb as a prognostic factor in UC treatment.

Results: During the three months observed, 17 (36.2%) patients failed treatment with tacrolimus. A comparison between the failure and remission groups showed a significant difference only in Alb in week 2, and in the week 2/week 0 Alb ratio, which showed the rate of change in Alb. The cut-off value of the week 2/week 0 Alb ratio that predicted failure was 1, and its area under the curve was 0.751 (95%CI: 0.604-0.898). In the Kaplan-Meier analysis, a week 2/week 0 Alb ratio ≤ 1 had a significantly higher failure rate than that of > 1; Cox proportional hazard regression analysis also showed that a week 2/week 0 Alb ratio ≤ 1 was an independent prognostic factor for failure within 3 mo after the start of tacrolimus treatment.

Conclusion: A week 2/week 0 Alb ratio ≤ 1 predicts failure within 3 mo of tacrolimus administration for UC. High failure risk exists with week 2 Alb values ≤ 1 on admission.

Keywords: Albumin; Tacrolimus; Ulcerative colitis.

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Conflict of interest statement

Conflict-of-interest statement: The authors received no financial support for the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Receiver-operating characteristic analysis for prediction of failure during 3 mo after the reach of tacrolimus high trough level.
Figure 2
Figure 2
Changes in serum albumin ratio of each week and the percentage of the number of serum albumin ratio > 1 and ≤ 1. Serum albumin (Alb) ratio at week 1 and week 2 shows the week 1/week 0 and week 2/week 0 Alb ratio, respectively. The percentage of the number of Alb ratio > 1 and ≤ 1 at week 1 and week 2 are shown in the bar graph.
Figure 3
Figure 3
Kaplan-Meier time-to-relapse curve of patients with ulcerative colitis in relation to the week 2/week 0 albumin ratio > 1 and ≤ 1.
See this image and copyright information in PMC

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