Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset.

IF 8.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Journal of Crohns & Colitis Pub Date : 2024-02-26 DOI:10.1093/ecco-jcc/jjad148
Rebecca K Grant, Gareth-Rhys Jones, Nikolas Plevris, Ruairi W Lynch, William M Brindle, Hayley A Hutchings, John G Williams, Laith Alrubaiy, Alan Watkins, Charlie W Lees, Ian D R Arnott
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Abstract

Background and aims: In 2020 we reported the ACE Index in acute colitis which used biochemical and endoscopic parameters to predict steroid non-response on admission in patients with acute ulcerative colitis [UC]. We aimed to validate the ACE Index in an independent cohort.

Methods: The validation cohort comprised patients screened as eligible for inclusion in the CONSTRUCT study, a prospective, randomized, placebo-controlled trial which compared the effectiveness of treatment with infliximab vs ciclosporin in patients admitted with acute UC. The CONSTRUCT cohort database was reviewed at The Edinburgh IBD Unit and the same biochemical and endoscopic variables and cut-off values as those in the derivation cohort were applied to the validation cohort.

Results: In total, 800 patients were identified; 62.5% [55/88] of patients with a maximum ACE Index of 3 did not respond to intravenous [IV] steroids (positive predictive value [PPV] 62.5%, negative predictive value [NPV] 79.8%). Furthermore, 79.8% [158/198] of patients with an ACE Index of 0 responded to IV steroids [PPV 79.8%, NPV 62.5%]. Receiver operator characteristic [ROC] curve analysis produced an area under the curve [AUC] of 0.663 [p < 0.001].

Conclusions: We have now reported and externally validated the ACE Index in acute colitis in a combined cohort of over 1000 patients from across the UK. The ACE Index may be used in conjunction with clinical judgement to help identify patients admitted with active UC who are at high risk of not responding to IV steroids. Further studies are required to improve objectivity and accuracy of assessment.

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急性结肠炎 ACE [白蛋白、CRP 和内镜] 指数的验证:CONSTRUCT 数据集分析。
背景和目的:2020 年,我们报告了急性结肠炎 ACE 指数,该指数使用生化和内镜参数预测急性溃疡性结肠炎(UC)患者入院时的类固醇无应答情况。我们的目的是在一个独立队列中验证 ACE 指数:该研究是一项前瞻性、随机、安慰剂对照试验,比较了英夫利昔单抗与环孢素对急性溃疡性结肠炎患者的治疗效果。爱丁堡 IBD 中心对 CONSTRUCT 队列数据库进行了审查,并对验证队列采用了与推导队列相同的生化和内镜变量及临界值:共鉴定出 800 例患者;在 ACE 指数最高为 3 的患者中,62.5% [55/88] 的患者对静脉注射类固醇无效(阳性预测值 [PPV] 62.5%,阴性预测值 [NPV] 79.8%)。此外,79.8% [158/198] ACE 指数为 0 的患者对静脉注射类固醇有反应 [PPV 79.8%,NPV 62.5%]。接收者操作特征曲线(ROC)分析得出的曲线下面积(AUC)为 0.663 [p 结论:我们现已报告并从外部验证了 ACE 指数在急性结肠炎中的应用,研究对象是来自英国的 1000 多名患者。ACE 指数可与临床判断结合使用,以帮助识别对静脉注射类固醇无效的高风险活动性 UC 患者。为提高评估的客观性和准确性,还需要进一步研究。
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来源期刊
Journal of Crohns & Colitis
Journal of Crohns & Colitis 医学-胃肠肝病学
CiteScore
15.50
自引率
7.50%
发文量
1048
审稿时长
1 months
期刊介绍: Journal of Crohns and Colitis is concerned with the dissemination of knowledge on clinical, basic science and innovative methods related to inflammatory bowel diseases. The journal publishes original articles, review papers, editorials, leading articles, viewpoints, case reports, innovative methods and letters to the editor.
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