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P274 Assessing the individual risk of acute severe colitis at diagnosis in a South Asian population

Powles S., Chong L., Hicks L., Han L., Omassoli J., Williams H., Orchard T.

Imperial College Healthcare NHS Trust St. Mary's Hospital, Department of Gastroenterology, London, United Kingdom

Background

A new index has been shown to predict acute severe colitis (ASC) in patients diagnosed with ulcerative colitis (UC) [1]. When applied to patients at the time of diagnosis, this index can predict the 3 year risk of ASC. This 3 point scoring system is the sum of the following indices – 1 point for extensive disease, 1 point for a C-reactive protein [CRP] >10 mg/l, and 1 point for a haemoglobin [Hb] <12 g/dl F or <14 g/dl M. A score of 3/3 gives a 70% predicted risk of developing ACS within 3 years. This index was developed in an Oxford UC cohort, and externally validated in cohorts in Cambridge (UK) and Uppsala (Sweden). It is not clear whether this index would apply accurately to a South Asian (SA) cohort who have a higher rate of extensive disease at diagnosis, but a less aggressive disease course [2] We aim to assess whether this index can be applied to a South Asian population.

Methods

South Asian UC patients diagnosed between January 2006 and December 2013 were identified from the hospital's IBD research database. Patients were included if the extent of disease, CRP and Hb data were accessible at the time of diagnosis. Electronic notes were accessed to provide follow up data regarding admissions and treatment in the 3 years following diagnosis. Patients lost to follow up were excluded.

Results

48 UC SA patients were identified over the study period who had the requisite clinical data available to enable a predictive score to be calculated. 6/48 of these patients developed ASC within 3 years of diagnosis. In all index score categories, South Asians patients had a lower percentage of ASC compared to the Oxford median predictive risk.

Table 1. South Asian cohort stratified by index score and number with ASC – Side to side comparison with Oxford Development cohort

Index Score0/31/32/33/3
Number of patients (n=48)1711173
Mean Hb (g/dL)14.213.111.810.8
Mean CRP (mg/L)$<5$7.312.314.3
% with extensive disease6% (1/17)27% (3/11)65% (11/17)100% (3/3)
% requiring steroid12% (2/17)18% (2/11)18% (3/17)67% (2/3)
% developed ASC by 3 years0% (0/17)18% (2/11)18% (3/17)33% (1/3)
Oxford median predictive risk [1]12%25%48%69%

Conclusion

This study suggests that this index over estimated the risk of developing ASC in a South Asian population, which would affect the utility of this index in SA patients where more extensive but less aggressive disease has been demonstrated. Larger studies are needed to confirm these findings.

References:

[1] Cesarini, M, (2016), Predicting the Individual Risk of Acute Severe Colitis at Diagnosis, J Crohns Colitis

[2] Walker, D. G., (2011), Differences in inflammatory bowel disease phenotype between South Asians and Northern Europeans living in North West London, UK., Am J Gastroenterol.