title: Parameters of a severe disease course in ulcerative colitis.
abstract: OBJECTIVE
  To detect high risk patients with a progressive disease course of ulcerative colitis (UC) requiring immunosuppressive therapy (IT).
  
  
  METHODS
  A retrospective, multicenter analysis of 262 UC patients from eight German tertiary inflammatory bowel disease centres was performed. Patients were divided into two groups depending on the patients need to initiate immunosuppressive therapy in the disease course. A comparison between the two groups was made with regard to demographics, clinical and laboratory parameters obtained within three months after UC diagnosis and the response to first medical therapy. Using this data, a prognostic model was established to predict the individual patients probability of requiring an immunosuppressive therapy.
  
  
  RESULTS
  In 104 (39.7%) out of 262 patients, UC therapy required an immunosuppressive treatment. Patients in this group were significantly younger at time of diagnosis (HR = 0.981 ± 0.014 per year, P = 0.009), and required significantly more often a hospitalisation (HR = 2.5 ± 1.0, P < 0.001) and a systemic corticosteroid therapy at disease onset (HR = 2.4 ± 0.8, P < 0.001), respectively. Response to steroid treatment was significantly different between the two groups of patients (HR = 5.2 ± 3.9 to 50.8 ± 35.6 compared to no steroids, P = 0.016 to P < 0.001). Furthermore, in the IT group an extended disease (HR = 3.5 ± 2.4 to 6.1 ± 4.0 compared to proctitis, P = 0.007 to P = 0.001), anemia (HR = 2.2 ± 0.8, P < 0.001), thrombocytosis (HR = 1.9 ± 1.8, P = 0.009), elevated C-reactive protein (CRP) (HR = 2.1 ± 0.9, P < 0.001), and extraintestinal manifestations in the course of disease (HR = 2.6 ± 1.1, P = 0.004) were observed. Six simple clinical items were used to establish a prognostic model to predict the individual risk requiring an IT. This probability ranges from less than 2% up to 100% after 5 years. Using this, the necessity of an immunosuppressive therapy can be predicted in 60% of patients. Our model can determine the need for an immunosuppressive drug therapy or if a "watch and wait" approach is reasonable already early in the treatment course of UC.
  
  
  CONCLUSIONS
  Using six simple clinical parameters, we can estimate the patients individual risk of developing a progressive disease course.
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stallmach
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Luisa
authors.initials: L
authors.lastname: Nickel
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehmann
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Bokemeyer
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bürger
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Hüppe
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kruis
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Susanna
authors.initials: S
authors.lastname: Nikolaus
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Preiss
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Sturm
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Niels
authors.initials: N
authors.lastname: Teich
authors.affiliation: Andreas Stallmach, Luisa Nickel, Martin Bürger, Carsten Schmidt, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena 07747, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Schmidt
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D003093:Colitis, Ulcerative / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D003661:Decision Support Techniques; D018450:Disease Progression; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D007166:Immunosuppressive Agents; D018836:Inflammation Mediators; D002097:C-Reactive Protein
keywords: Clinical practice; Inflammatory bowel disease; Parameter; Prediction model; Ulcerative colitis