Poster (15W163)

CRP/Albumin ratio; a novel predictor of early colectomy in Acute Severe Ulcerative Colitis

Author(s)

Gibson DJ, Doherty J, Nolan J, Keegan D, Byrne K, Martin ST, Buckley M, Sheridan J, Horgan G, Mulcahy HE, Cullen G, Doherty GA

Department(s)/Institutions

Centre for Colorectal Disease, St Vincent's University Hospital, Dublin 4

Introduction

Dose optimisation of infliximab (IFX) with an accelerated induction in Acute Severe Ulcerative Colitis (ASUC) reduces initial colectomy rates. However, it is unclear whether all steroid non-responsive ASUC patients should receive an accelerated IFX induction. It is known that hypoalbuminaemia is strongly associated with colectomy while a raised CRP at IFX induction is favourable. The relationship between CRP and albumin has not been explored.

Method

A retrospective study of a prospectively maintained database of 3600 attending a single centre was performed. Patients admitted with ASUC over a 5 year period from January 2010- December 2014 were identified. All patients were initially treated with IV steroids for histologically confirmed ulcerative colitis. Patient demographics were collected and CRP and albumin levels were recorded at day 1 and day 3 of admission. ROC statistics were used to determine the optimal CRP/Albumin ratio for 30 day colectomy. Kaplan Meier Survival analysis was then performed to evaluate the relationship between high and low CRP/Albumin on time to colectomy.

Results

129 patients with ASUC were admitted during a 5 year period. The median follow up was 2.3 years. 50 patients (37%) were steroid responsive, 58 patients (45%) received rescue infliximab. 24 patients (19%) required colectomy within 30 days of admission, while a further 14 (11%) required colectomy during follow-up. By ROC statistics, day 3 CRP/albumin ratio was a more accurate marker of subsequent 30 day colectomy than day 3 albumin alone (AUC =0.78 (p<0.001) vs AUC 0.70 (p=0.002)) with optimal CRP/albumin ratio to predict colectomy of 1.75 (sensitivity 72%, specificity 75%). Kaplan Meier survival analysis revealed predicted 3 year colectomy rates of 50% vs 20% in patients with day 3 CRP/Albumin ratio>1.75 and <1.75 respectively (p<0.001).

Conclusions

A raised day 3 CRP/Alb is strongly associated with subsequent need for colectomy. Early introduction of infliximab at this stage, using an accelerated induction regimen may be justified to reduce risk of subsequent colectomy in this high risk group.

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