title: Prognostic factors affecting early colectomy in patients with moderate to severe ulcerative colitis treated with calcineurin inhibitors.
abstract: Calcineurin inhibitors (CNIs) such as cyclosporine A (CSA) and tacrolimus (FK506) are often used as a second-line drug for steroid-refractory or steroid-dependent patients with ulcerative colitis (UC). The aim of the present study was to determine the prognostic factors for early colectomy. A total of 85 hospitalized patients with UC (CSA, 50 patients; FK506, 35 patients) were enrolled. Colectomy carried out within 60 days of starting CNI therapy was defined as 'early colectomy'. To assess the prognostic factors affecting early colectomy, clinical practical variables, including the Onodera-prognostic nutritional index (O-PNI): 10xAlb+0.005× (total lymphocyte count), were analyzed. The results demonstrated that the significant factors predicting early colectomy were i) disease severity, ii) immunomodulator-naïve history, iii) lower serum hematocrit, iv) lower serum albumin and v) lower O-PNI. In addition, the significant factors predicting overall colectomy were as follows: i) C7-HRP positivity and ii) >10,000 mg of prednisolone used prior to the initiation of CNI treatment. The combination of hematocrit and O-PNI enhanced the prediction of early colectomy. Clinical variables such as hematocrit and O-PNI were the significant factors predicting colectomy. These results may be used as a guide to predict the outcome of patients with UC in clinical settings.
authors.affiliation: Division of Endoscopy, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Ban
authors.affiliation: Division of Gastroenterology, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Bamba
authors.affiliation: Division of Gastroenterology, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nishida
authors.affiliation: Division of Gastroenterology, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Inatomi
authors.affiliation: Division of Gastroenterology, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Shioya
authors.affiliation: Division of Gastroenterology, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
authors.forename: Ken-Ichiro
authors.initials: KI
authors.lastname: Takahashi
authors.affiliation: Division of Gastroenterology, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Imaeda
authors.affiliation: Division of Gastroenterology, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Murata
authors.affiliation: Division of Clinical Nutrition, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Sasaki
authors.affiliation: Department of Comprehensive Internal Medicine, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Tsujikawa
authors.affiliation: Division of Gastroenterology, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Andoh
keywords: calcineurin inhibitors; colectomy; cyclosporine A; tacrolimus; ulcerative colitis