Background and aim
Acute severe ulcerative colitis (ASUC) is a life-threatening condition that requires timely referral for therapy. Sarcopenia has been associated with clinical outcomes of inflammatory bowel disease (IBD). This study investigated the role of sarcopenia in predicting the clinical course of ASUC.
This retrospective cohort study included ASUC patients with abdominal CT scans. Univariate and multivariable regression analyses were performed to identify a practical predictive index for the clinical course of ASUC.
Of 233 included patients, 151 had intravenous corticosteroid (IVS) failure, among whom 32 received surgery without medical rescue therapy. Fifty patients underwent colectomy after medical rescue therapy failure. Of these 82 surgical patients, 42 suffered postoperative complications. Multivariable regression analysis showed that sarcopenia remained an independent risk factor for IVS failure (OR=2.969; 95% CI, 1.547–5.701; p = 0.001), colectomy after medical rescue therapy failure (OR=3.411; 95% CI, 1.147–10.141; p = 0.027), and postoperative complications after colectomy (OR=4.157; 95% CI, 1.364–12.667; p = 0.012). During follow-up, patients with colectomy after first-line treatment had a lower comprehensive complication index and better health-related quality of life.
Sarcopenia is useful in predicting the clinical course and postoperative outcomes of ASUC.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Digestive and Liver Disease
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Ulcerative colitis.Lancet. 2017; 389: 1756-1770
- Outcomes for ulcerative colitis with delayed emergency colectomy are worse when controlling for preoperative risk factors.Dis Colon Rectum. 2019; 62: 600-607
- Colectomy rate in acute severe ulcerative colitis in the infliximab era.Dig Liver Dis. 2008; 40: 821-826
- Contemporary medical management of acute severe ulcerative colitis.Inflamm Bowel Dis. 2019; 25: 56-66
- Predicting the course of disease in hospitalized patients with acute severe ulcerative colitis.Inflamm Bowel Dis. 2019; 25: 541-546
- Current management of severe ulcerative colitis.Nat Clin Pract Gastroenterol Hepatol. 2007; 4: 92-101
- Intensive intravenous regimen for severe attacks of ulcerative colitis.Lancet. 1974; 1: 1067-1070
- Systematic review and meta-analysis: optimal salvage therapy in acute severe ulcerative colitis.Inflamm Bowel Dis. 2019; 25: 1169-1186
- Sarcopenia is a novel predictor of the need for rescue therapy in hospitalized ulcerative colitis patients.J Crohns Colitis. 2018; 12: 1036-1041
- Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial.Lancet. 2012; 380: 1909-1915
- Third european evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders.J Crohns Colitis. 2017; 11: 649-670
- Changes in the rate of and trends in colectomy for ulcerative colitis during the era of biologics and calcineurin inhibitors based on a Japanese nationwide cohort study.Surg Today. 2019; 49: 1066-1073
- Preliminary report: cyclosporin in treatment of severe active ulcerative colitis.Lancet. 1990; 336: 16-19
- Faecal calprotectin and UCEIS predict short-term outcomes in acute severe colitis: prospective cohort study.J Crohns Colitis. 2017; 11: 1309-1316
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Early postoperative decrease of serum albumin predicts surgical outcome in patients undergoing colorectal resection.Dis Colon Rectum. 2017; 60: 326-334
- Placebo effect on the health-related quality of life of inflammatory bowel disease patients: a systematic review with meta-analysis.J Crohns Colitis. 2018; 12: 1232-1244
- Reduced paraspinous muscle area is associated with post-colectomy complications in children with ulcerative colitis.J Pediatr Surg. 2018; 53: 477-482
- Abdominal fat: standardized technique for measurement at CT.Radiology. 1999; 211: 283-286
- Prevalence of sarcopenia and its impact on postoperative outcome in patients with Crohn's disease undergoing bowel resection.JPEN J Parenter Enteral Nutr. 2017; 41: 592-600
- Practice parameters committee of the American College of G. Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, practice parameters committee.Am J Gastroenterol. 2010; 105 (quiz 24): 501-523
- Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second-line medical therapy or surgery.Aliment Pharmacol Ther. 2004; 19: 1079-1087
- CRP/albumin ratio: an early predictor of steroid responsiveness in acute severe ulcerative colitis.J Clin Gastroenterol. 2018; 52: e48-e52
- Sarcopenia as a predictor of poor surgical and oncologic outcomes after abdominal surgery for digestive tract cancer: a prospective cohort study.Clin Nutr. 2019; 38: 2881-2888
- Computed tomography-assessed skeletal muscle mass as a predictor of outcomes in lung cancer surgery.Ann Thorac Surg. 2019; 108: 1555-1564
- Effects of sarcopenia on prognosis after resection of gallbladder cancer.J Gastrointest Surg. 2020; 24: 1082-1091
- Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn's disease.PLoS ONE. 2017; 12 (e0180036)
- Skeletal muscle depletion correlates with disease activity in ulcerative colitis and is reversed after colectomy.Clin Nutr. 2017; 36: 1586-1592
- Nutritional aspects in inflammatory bowel diseases.Nutrients. 2020; : 12
- Delving into disability in Crohn's disease: dysregulation of molecular pathways may explain skeletal muscle loss in Crohn's disease.J Crohns Colitis. 2014; 8: 626-634
- Long-term efficacy and safety of cyclosporine in a cohort of steroid-refractory acute severe ulcerative colitis patients from the ENEIDA registry (1989-2013): a nationwide multi-center study.Am J Gastroenterol. 2017; 112: 1709-1718
- Lower subcutaneous or visceral adiposity assessed by abdominal computed tomography could predict adverse outcome in patients with Crohn's disease.J Crohns Colitis. 2018; 12: 1429-1437
- Sarcopenia: origins and clinical relevance.Clin Geriatr Med. 2011; 27: 337-339
- Management of acute ulcerative colitis.Dis Colon Rectum. 2018; 61: 1010-1013
- Systematic review: outcomes and post-operative complications following colectomy for ulcerative colitis.Aliment Pharmacol Ther. 2016; 44: 807-816
- ACG clinical guideline: ulcerative colitis in adults.Am J Gastroenterol. 2019; 114: 384-413
- Comparable perioperative outcomes, long-term outcomes, and quality of life in a retrospective analysis of ulcerative colitis patients following 2-stage versus 3-stage proctocolectomy with ileal pouch-anal anastomosis.Int J Colorectal Dis. 2019; 34: 491-499
- Sarcopenia and inflammatory bowel disease: a systematic review.Inflamm Bowel Dis. 2019; 25: 67-73
- Impact of sarcopenia on surgical site infection after restorative proctocolectomy for ulcerative colitis.Surg Today. 2017; 47: 92-98
Published online: April 29, 2021
Accepted: March 24, 2021
Received in revised form: March 5, 2021
Received: January 13, 2021
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Sarcopenia and acute severe ulcerative colitis patientsDigestive and Liver DiseaseVol. 53Issue 11
- PreviewGe et al. recently investigated the association between sarcopenia and clinical prognosis of patients with acute severe ulcerative colitis (ASUC) . In this retrospective cohort study, after adjusting for confounding factors by multivariate regression analysis, the authors revealed that sarcopenia was associated with the poor prognosis of ASUC patients, suggesting that sarcopenia could be used in clinical practice to predict the prognosis and risk stratification of ASUC patients. Definitely, the author's great efforts provide an important basis for the treatment strategy of ASUC patients.