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- Title
Superior predictive value of transmural over endoscopic severity for colectomy risk in ulcerative colitis: a multicentre prospective cohort study.
- Authors
Sed, Nicole Piazza O; Noviello, Daniele; Filippi, Elisabetta; Conforti, Francesco; Furfaro, Federica; Fraquelli, Mirella; Costantino, Andrea; Danese, Silvio; Vecchi, Maurizio; Fiorino, Gionata; Allocca, Mariangela; Caprioli, Flavio
- Abstract
Background and Aims Endoscopic activity is associated with an increased risk of surgery in patients with ulcerative colitis [UC]. Transmural activity, as defined by Milan Ultrasound Criteria [MUC] > 6.2, reliably detects endoscopic activity in patients with UC. The present study aimed to assess in UC patients whether transmural severity is a better predictor of colectomy as compared to endoscopy. Methods Consecutive adult UC patients were recruited in two IBD Referral Centres and underwent colonoscopy and intestinal ultrasound in a blinded fashion. The need for colectomy was assessed at follow-up. Univariable and multivariable logistic and Cox regression analyses were performed. Receiver operating characteristic [ROC] analysis was used to compare MUC baseline values and Mayo Endoscopic Scores [MES] in predicting colectomy risk. Results Overall, 141 patients were enrolled, and 13 underwent colectomy in the follow-up period. Both MES (hazard ratio [HR]: 3.15, 95% confidence interval [CI]: 1.18–8.37, p = 0.02) and MUC [HR: 1.48, 95% CI: 1.19–1.76, p < 0.001] were associated with colectomy risk, but only MUC was independently associated with this event on multivariable analysis [HR: 1.46, 95% CI: 1.06–2.02, p = 0.02]. MUC was the only independent variable associated with colectomy risk in patients with clinically active disease (odds ratio [OR]: 1.53 [1.03–2.27], p = 0.03). MUC demonstrated higher accuracy than MES (area under ROC curve [AUROC] 0.83, 95% CI: 0.75–0.92 vs 0.71, 95% CI: 0.62–0.80) and better performance for predicting colectomy [ p = 0.02]. The optimal MUC score cut-off value for predicting colectomy, as assessed by the Youden index, was 7.7. Conclusions A superior predictive value was found for transmural vs endoscopic severity for colectomy risk in UC patients.
- Publication
Journal of Crohn's & Colitis, 2024, Vol 18, Issue 2, p291
- ISSN
1873-9946
- Publication type
Article
- DOI
10.1093/ecco-jcc/jjad152