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P240 Correlation between the Ulcerative Colitis Endoscopic Index of severity (UCEIS) and intestinal mucosal calprotectin (IMC) in acute severe ulcerative colitis.

J. Chamoun*, L. Wang, C. Corte, L. Clifton, E. Wendt, M. Guirgis, S. Travis, S. Keshav

John Radcliffe Hospital, Translational Gastroenterology Unit, Oxford, United Kingdom

Background

Predicting the outcome of acute severe colitis (ASC) with endoscopic information has been examined using the Ulcerative Colitis Endoscopic index of Severity (UCEIS). Higher scores predict the need for rescue therapy, but this index has yet to be correlated with calprotectin, a marker of intestinal inflammation. Intestinal mucosal calprotectin (IMC) itself has yet to be examined as a predictor of outcome in ASC.

Methods

We retrospectively examined a cohort of 52 cases of ASC admitted between July 2010 and November 2012, using a database that included clinical parameters and UCEIS score on admission, inpatient management, response to therapy, and outcome defined as need for colectomy or rescue therapy with either infliximab or ciclosporin. Sections of archived biopsies taken during admission were stained for calprotectin using immunohistochemistry for the S100A8/A9 heterodimer. The IMC count was defined as the average number of calprotectin positive cells per 20x high power field (hpf) determined by counting 5 hpfs per specimen. IMC counts and other data were analysed using multivariate logistic regression. Relationships between UCEIS (range 0-8) and IMC count were analysed using Student's t-tests and rank sum Mann-Whitney tests as appropriate.

Results

24/52 (46 %) patients had rescue therapy and 11/52 (21 %) underwent colectomy. In the entire cohort, the mean IMC count was 202 (SD ± 112, median 204, range 1 to 540). The UCEIS score was grouped into three: <4, 5-6 and 7-8. No significant differences in mean IMC numbers were found between the three UCEIS groups (171, 237, 183 positive cells/hpf with p-values 0.07, 0.71 and 0.24 respectively). IMC did not predict the need for colectomy (p= 0.10) (mean IMC count for colectomy and non-colectomy patients was 145 and 216 respectively). However, higher IMC counts were associated with rescue therapy (95 % CI 1.00-1.002; p=0.03) (mean IMC count for rescue therapy and non-rescue therapy patients 239 and 171 respectively). The odds ratio of having rescue therapy increased with the IMC; an increase by 50 calprotectin positive cells/hpf increased the odds by 1.54. On multivariate logistic regression analysis, a model that significantly predicted the need for rescue therapy included the IMC count, the UCEIS score, and age as predictors (p= 0.0008).

 

ECCOJC jju027 P240 F0001

“Figure 1: Mean IMC count and the need for rescue therapy with ciclosporin or infliximab”

 

Conclusion

Intestinal mucosal calprotectin did not correlate with UCEIS in this small cohort, although it did predict the need for rescue therapy in ASC. IMC may therefore provide a valuable correlate in evaluating the severity of mucosal inflammation.