Haotian Chen , Lexi Wu , Mengyu Wang , Bule Shao , Lingna Ye , Yu Zhang , Qian Cao
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The primary outcome was the need for step-up treatment, which included the use of corticosteroids, immunomodulatory, or surgery during admission and follow-up. Data were analyzed using the χ<sup>2</sup> or Fisher exact test, Spearman test, <em>t</em>-test, and Mann–Whitney <em>U</em> test.</p></div><div><h3>Results</h3><p>Totally, 65 patients were enrolled, of whom 12 (18.5%) needed step-up treatment due to nonresponse to mesalazine. The UCEIS score, MES, and the ulcerative colitis disease activity index (UCDAI) score were significantly higher in patients who had nonresponse to mesalazine (UCEIS score: 6.92 ± 0.69 vs. 4.45 ± 1.17, <em>p</em> < 0.001; MES: 2.67 ± 0.49 vs. 2.15 ± 0.69, <em>p</em> = 0.024; UCDAI score: 9.33 ± 1.87 vs. 6.70 ± 2.38, <em>p</em> = 0.002). In the multivariate analysis, the UCEIS score (OR = 25.65, 95% CI: 3.048–45.985, <em>p</em> = 0.003), UCDAI score (OR = 1.605, 95% CI: 1.144–2.254, <em>p</em> = 0.006), and C-reactive protein level (OR = 1.056, 95% CI: 1.006–1.108, <em>p</em> = 0.026) were independent risk factors of nonresponse. The area under the ROC curve of UCEIS was 0.95, with a sensitivity of 100% and specificity of 84.6%, a cut-off value of 6, which outperformed the MES with an area under the ROC curve of 0.70. When the UCEIS score ≥6, 60% of patients eventually needed step-up treatment.</p></div><div><h3>Conclusions</h3><p>The UCEIS is a useful instrument for predicting the therapeutic effect in patients with UC treated with mesalazine. The high probability of mesalazine treatment failure and benefits of other therapies should be discussed in patients with baseline UCEIS score ≥6.</p></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.lers.2021.04.003","citationCount":"3","resultStr":"{\"title\":\"Use of the ulcerative colitis endoscopic index of severity and Mayo endoscopic score for predicting the therapeutic effect of mesalazine in patients with ulcerative colitis\",\"authors\":\"Haotian Chen , Lexi Wu , Mengyu Wang , Bule Shao , Lingna Ye , Yu Zhang , Qian Cao\",\"doi\":\"10.1016/j.lers.2021.04.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>The ulcerative colitis endoscopic index of severity (UCEIS) and the Mayo endoscopic score (MES) are developed as objective methods of evaluating endoscopic severity in patients with ulcerative colitis (UC). The aim of this study is to investigate the diagnostic accuracy of the UCEIS and MES in predicting the patient's response to mesalazine.</p></div><div><h3>Methods</h3><p>Consecutive patients with UC who had undergone colonoscopy within 1 month before starting mesalazine between October 2011 and July 2016 were retrospectively collected at the Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The median follow-up was 81 months, and all the data were analyzed in January 2021. The primary outcome was the need for step-up treatment, which included the use of corticosteroids, immunomodulatory, or surgery during admission and follow-up. Data were analyzed using the χ<sup>2</sup> or Fisher exact test, Spearman test, <em>t</em>-test, and Mann–Whitney <em>U</em> test.</p></div><div><h3>Results</h3><p>Totally, 65 patients were enrolled, of whom 12 (18.5%) needed step-up treatment due to nonresponse to mesalazine. The UCEIS score, MES, and the ulcerative colitis disease activity index (UCDAI) score were significantly higher in patients who had nonresponse to mesalazine (UCEIS score: 6.92 ± 0.69 vs. 4.45 ± 1.17, <em>p</em> < 0.001; MES: 2.67 ± 0.49 vs. 2.15 ± 0.69, <em>p</em> = 0.024; UCDAI score: 9.33 ± 1.87 vs. 6.70 ± 2.38, <em>p</em> = 0.002). In the multivariate analysis, the UCEIS score (OR = 25.65, 95% CI: 3.048–45.985, <em>p</em> = 0.003), UCDAI score (OR = 1.605, 95% CI: 1.144–2.254, <em>p</em> = 0.006), and C-reactive protein level (OR = 1.056, 95% CI: 1.006–1.108, <em>p</em> = 0.026) were independent risk factors of nonresponse. The area under the ROC curve of UCEIS was 0.95, with a sensitivity of 100% and specificity of 84.6%, a cut-off value of 6, which outperformed the MES with an area under the ROC curve of 0.70. When the UCEIS score ≥6, 60% of patients eventually needed step-up treatment.</p></div><div><h3>Conclusions</h3><p>The UCEIS is a useful instrument for predicting the therapeutic effect in patients with UC treated with mesalazine. The high probability of mesalazine treatment failure and benefits of other therapies should be discussed in patients with baseline UCEIS score ≥6.</p></div>\",\"PeriodicalId\":32893,\"journal\":{\"name\":\"Laparoscopic Endoscopic and Robotic Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2021-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.lers.2021.04.003\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Laparoscopic Endoscopic and Robotic Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2468900921000190\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laparoscopic Endoscopic and Robotic Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468900921000190","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 3
摘要
目的建立溃疡性结肠炎内镜严重程度指数(UCEIS)和Mayo内镜评分(MES),作为评估溃疡性结肠炎(UC)患者内镜严重程度的客观方法。本研究的目的是探讨UCEIS和MES在预测患者对美沙拉嗪的反应方面的诊断准确性。方法回顾性收集2011年10月至2016年7月浙江大学医学院邵逸夫医院消化内科1个月内连续行结肠镜检查的UC患者。中位随访81个月,所有数据于2021年1月进行分析。主要结局是需要加强治疗,包括在入院和随访期间使用皮质类固醇、免疫调节剂或手术。数据分析采用χ2或Fisher精确检验、Spearman检验、t检验和Mann-Whitney U检验。结果共纳入65例患者,其中12例(18.5%)因对美沙拉嗪无反应需要加强治疗。美沙拉嗪无反应患者的UCEIS评分、MES和溃疡性结肠炎疾病活动指数(UCDAI)评分均显著高于对照组(UCEIS评分:6.92±0.69比4.45±1.17,p <0.001;MES: 2.67±0.49 vs. 2.15±0.69,p = 0.024;UCDAI得分:9.33±1.87和6.70±2.38,p = 0.002)。在多因素分析中,UCEIS评分(OR = 25.65, 95% CI: 3.048 ~ 45.985, p = 0.003)、UCDAI评分(OR = 1.605, 95% CI: 1.144 ~ 2.254, p = 0.006)和c反应蛋白水平(OR = 1.056, 95% CI: 1.006 ~ 1.108, p = 0.026)是无反应的独立危险因素。UCEIS的ROC曲线下面积为0.95,灵敏度为100%,特异性为84.6%,截断值为6,优于MES的ROC曲线下面积为0.70。当UCEIS评分≥6时,60%的患者最终需要加强治疗。结论UCEIS是预测美沙拉嗪治疗UC疗效的有效工具。对于基线UCEIS评分≥6的患者,应讨论美萨拉嗪治疗失败的高概率和其他治疗的益处。
Use of the ulcerative colitis endoscopic index of severity and Mayo endoscopic score for predicting the therapeutic effect of mesalazine in patients with ulcerative colitis
Objective
The ulcerative colitis endoscopic index of severity (UCEIS) and the Mayo endoscopic score (MES) are developed as objective methods of evaluating endoscopic severity in patients with ulcerative colitis (UC). The aim of this study is to investigate the diagnostic accuracy of the UCEIS and MES in predicting the patient's response to mesalazine.
Methods
Consecutive patients with UC who had undergone colonoscopy within 1 month before starting mesalazine between October 2011 and July 2016 were retrospectively collected at the Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The median follow-up was 81 months, and all the data were analyzed in January 2021. The primary outcome was the need for step-up treatment, which included the use of corticosteroids, immunomodulatory, or surgery during admission and follow-up. Data were analyzed using the χ2 or Fisher exact test, Spearman test, t-test, and Mann–Whitney U test.
Results
Totally, 65 patients were enrolled, of whom 12 (18.5%) needed step-up treatment due to nonresponse to mesalazine. The UCEIS score, MES, and the ulcerative colitis disease activity index (UCDAI) score were significantly higher in patients who had nonresponse to mesalazine (UCEIS score: 6.92 ± 0.69 vs. 4.45 ± 1.17, p < 0.001; MES: 2.67 ± 0.49 vs. 2.15 ± 0.69, p = 0.024; UCDAI score: 9.33 ± 1.87 vs. 6.70 ± 2.38, p = 0.002). In the multivariate analysis, the UCEIS score (OR = 25.65, 95% CI: 3.048–45.985, p = 0.003), UCDAI score (OR = 1.605, 95% CI: 1.144–2.254, p = 0.006), and C-reactive protein level (OR = 1.056, 95% CI: 1.006–1.108, p = 0.026) were independent risk factors of nonresponse. The area under the ROC curve of UCEIS was 0.95, with a sensitivity of 100% and specificity of 84.6%, a cut-off value of 6, which outperformed the MES with an area under the ROC curve of 0.70. When the UCEIS score ≥6, 60% of patients eventually needed step-up treatment.
Conclusions
The UCEIS is a useful instrument for predicting the therapeutic effect in patients with UC treated with mesalazine. The high probability of mesalazine treatment failure and benefits of other therapies should be discussed in patients with baseline UCEIS score ≥6.
期刊介绍:
Laparoscopic, Endoscopic and Robotic Surgery aims to provide an academic exchange platform for minimally invasive surgery at an international level. We seek out and publish the excellent original articles, reviews and editorials as well as exciting new techniques to promote the academic development.
Topics of interests include, but are not limited to:
▪ Minimally invasive clinical research mainly in General Surgery, Thoracic Surgery, Urology, Neurosurgery, Gynecology & Obstetrics, Gastroenterology, Orthopedics, Colorectal Surgery, Otolaryngology, etc.;
▪ Basic research in minimally invasive surgery;
▪ Research of techniques and equipments in minimally invasive surgery, and application of laparoscopy, endoscopy, robot and medical imaging;
▪ Development of medical education in minimally invasive surgery.