[Predictors of colectomy in patients with ulcerative colitis. A cohort analysis of 184 cases].
BACKGROUND
At the present time procto-colectomy is the only potentially curative therapeutic measure for patients with ulcerative colitis (UC). Due to its morbidity and mortality, several prognostic indexes have been proposed to identify subjects in whom surgery could be beneficial. However, they have limited availability or they are very cumbersome for the individual patient.


OBJECTIVE
To analyze demographic, clinical and biochemical variables in a group of 184 Mexican patients with UC in order to identify predicting factors for procto-colectomy.


METHODS
Subjects were divided into two groups: A. Those in whom a procto-colectomy was performed (n = 52) and B. Patients on medical treatment in = 132). Continuous variables were analyzed by means of the Student's t test and categorical variables by means of chi-square statistic. A multivariate analysis was performed using logistic regression.


RESULTS
The main indication for surgery was failure to medical treatment (78%). Procto-colectomy was elective in 28 cases and an emergency procedure in 14 (7 failures to medical treatment, 4 colonic perforations, 2 toxic megacolons and 1 uncontrolled hemorrhage). All operated subjects had pancolitis and showed more bloody bowel movements per day (> 10), fever (> 38.5 degrees C), tachycardia, hipoalbuminemia and hospitalizations. Only hypoalbuminemia in subjects with universal colitis was consistently associated to procto-colectomy.


CONCLUSIONS
Pancolitis, hypoalbuminemia and previous hospitalizations were the strongest predictors of procto-colectomy in our cohort. Thus, serum protein determinations can be useful in patients with universal UC to decide surgical therapy.
Choquet
Arsenio
A
Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF.
Yamamoto-Furusho
Jesús K
JK
Reyes
Edgardo
E
Takahashi-Monroy
Takeshi
T
Vargas-Vorácková
Florencia
F
Uscanga
Luis
L
D000328:Adult; D015331:Cohort Studies; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis