Predictors of colectomy in patients with ulcerative colitis. A cohort analysis of 184 cases [Predictores de colectomía en enfermos con colitis ulcerativa crónica inespecífica (CUCI). Análisis de una cohorte de 184 casos]
Por:
Choquet A., Yamamoto-Furusho J.K., Reyes E., Takahashi-Monroy T., Vargas-Vorácková F., Uscanga L.
Publicada:
1 ene 2004
Resumen:
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. Aim. 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. Patients and methods. Subjects were divided into two groups: A. Those in whom a procto-colectomy was performed (n = 52) and B. Patients on medical treatment (n = 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 poncolitis and showed more bloody bowel movements per day (> 10), fever (> 38.5 °C), tachycardia, hipoalbuminemia and hospitalizations. Only hypoalbuminemia in subjects with universal colitis was consistently associated to procto-colectomy. Conclusion. 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.
Filiaciones:
Choquet A.:
Departamento de Gastroenterologia, Inst. Nacl. Ciencias Med./Nutricion, Vasco de Quiroga 15, Tlalpan 14000 México DF, Mexico
Yamamoto-Furusho J.K.:
Departamento de Gastroenterologia, Inst. Nacl. Ciencias Med./Nutricion, Vasco de Quiroga 15, Tlalpan 14000 México DF, Mexico
Reyes E.:
Departamento de Anatomia Patologica, Inst. Nacl. Ciencias Med./Nutricion, Vasco de Quiroga 15, Tlalpan 14000 México DF, Mexico
Takahashi-Monroy T.:
Dirección de Cirugía, Inst. Nacl. Ciencias Med./Nutricion, Vasco de Quiroga 15, Tlalpan 14000 México DF, Mexico
Vargas-Vorácková F.:
Departamento de Gastroenterologia, Inst. Nacl. Ciencias Med./Nutricion, Vasco de Quiroga 15, Tlalpan 14000 México DF, Mexico
Uscanga L.:
Departamento de Gastroenterologia, Inst. Nacl. Ciencias Med./Nutricion, Vasco de Quiroga 15, Tlalpan 14000 México DF, Mexico
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