Year 2024 / Volume 116 / Number 3
Original
Development and validation of a nomogram to predict non-response to 5-aminosalicylic acid in patients with ulcerative colitis

124-131

DOI: 10.17235/reed.2023.9703/2023

Cong Dai, Zi-Yuan Dong, Yi-Nuo Wang, Yu-Hong Huang, Min Jiang,

Abstract
Background: there are some patients with ulcerative colitis (UC) who have non-response (NR) to 5-aminosalicylic acid (5-ASA). To promote individualized treatment in UC patients, it is crucial to identify valid predictors to estimate NR to 5-ASA. Therefore, this study aimed to identify the predictive value of clinical and biochemical markers and to construct a nomogram model predicting NR to 5-ASA in patients with UC. Methods: data of patients diagnosed with UC in the First Hospital of China Medical University between January 2012 and December 2020 were retrospectively analyzed. Primary outcome was the proportion of NR to 5-ASA. Multivariable logistic regression was used to construct prediction models. Area under the curve (AUC), calibration and decision curve analyses (DCA) were assessed in the validation cohort. Results: of 284 UC patients who were treatment-naive, 86 (30.3 %) had NR to 5-ASA. Univariate regression analysis showed that disease classification (DC) (p = 0.008), monocytes (MONO) (p = 0.041), platelet distribution width (PDW) (p = 0.027), serum total cholesterol (TC) (p = 0.031) and α1 globulin (p < 0.001) were strongly associated with NR to 5-ASA. Receiver operating characteristics (ROC) analysis indicated the AUC was 0.852, it showed that this model has a good degree of discrimination. The DCA curve showed that the predicted probability is 0.0-96.0 %. Conclusion: this study developed a predictive model with good discrimination and calibration, and high clinical validity, which can effectively estimate the risk of NR to 5-ASA. DC, MONO, PDW, TC and α1 globulin can be used as predictors for NR to 5-ASA in UC patients.
Lay Summary
Background There are some patients with UC who have non-response (NR) to 5-ASA. To promote individualized treatment in UC patients, it is crucial to identify valid predictors to estimate NR to 5-ASA. Therefore, we aimed to identify the predictive value of clinical and biochemical markers and to construct a nomogram model predicting NR to 5-ASA in patients with UC. Results Of 284 UC patients who were treatment-naive, 86 (30.3%) had NR to 5-ASA. Univariate regressions showed that disease classification (DC) (p = 0.008), monocytes (MONO) (p = 0.041), platelet distribution width (PDW) (p = 0.027), serum total cholesterol (TC) (p = 0.031), and α1 globulin (p < 0.001) were strongly associated with NR to 5-ASA. ROC analysis indicated the AUC was 0.852, it showed that this model has a good degree of discrimination. The DCA curve showed that the predicted probability is 0.0%-96.0%. Conclusion Our study developed a predictive model with good discrimination and calibration, and high clinical validity, which can effectively estimate the risk of NR to 5-ASA. DC, MONO, PDW, TC, and α1 globulin can be used as predictors for NR to 5-ASA in UC patients.
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References
1 Fiocchi C. Inflammatory bowel disease: new insights into mechanisms of inflammation and increasingly customized approaches to diagnosis and therapy. Curr Opin Gastroenterol. 2004;20(4):309-310.
2 Schmidt C, Grunert PC, Stallmach A. An Update for Pharmacologists on New Treatment Options for Inflammatory Bowel Disease: The Clinicians' Perspective. Front Pharmacol. 2021;12:655054.
3 Hanauer SB. Oral or Topical 5-ASA in Ulcerative Colitis. Dig Dis. 2016;34(1-2):122-124.
4 Liu L, Wei Y, Wei X. The Immune Function of Ly6Chi Inflammatory Monocytes During Infection and Inflammation. Curr Mol Med. 2017;17(1):4-12.
5 Coillard A, Segura E. In vivo Differentiation of Human Monocytes. Front Immunol. 2019;10:1907.
6 Guilliams M, Mildner A, Yona S. Developmental and Functional Heterogeneity of Monocytes. Immunity. 2018;49(4):595-613.
7 Gren ST, Grip O. Role of Monocytes and Intestinal Macrophages in Crohn's Disease and Ulcerative Colitis. Inflamm Bowel Dis. 2016;22(8):1992-1998.
8 Rhodes JM, Jewell DP. Motility of neutrophils and monocytes in Crohn's disease and ulcerative colitis. Gut. 1983;24(1):73-77.
9 Jones GR, Bain CC, Fenton TM, et al. Dynamics of Colon Monocyte and Macrophage Activation During Colitis. Front Immunol. 2018;9:2764.
10 Nakanishi M, Matz A, Klemashevich C, Rosenberg DW. Dietary Walnut Supplementation Alters Mucosal Metabolite Profiles During DSS-Induced Colonic Ulceration. Nutrients. 2019;11(5).
11 Schleier L, Wiendl M, Heidbreder K, et al. Non-classical monocyte homing to the gut via alpha4beta7 integrin mediates macrophage-dependent intestinal wound healing. Gut. 2020;69(2):252-263.
12 Magnusson MK, Strid H, Isaksson S, et al. Response to infliximab therapy in ulcerative colitis is associated with decreased monocyte activation, reduced CCL2 expression and downregulation of Tenascin C. J Crohns Colitis. 2015;9(1):56-65.
13 Cherfane CE, Gessel L, Cirillo D, Zimmerman MB, Polyak S. Monocytosis and a Low Lymphocyte to Monocyte Ratio Are Effective Biomarkers of Ulcerative Colitis Disease Activity. Inflamm Bowel Dis. 2015;21(8):1769-1775.
14 Zamora C, Canto E, Nieto JC, et al. Inverse Association Between Circulating Monocyte-Platelet Complexes and Inflammation in Ulcerative Colitis Patients. Inflamm Bowel Dis. 2018;24(4):818-828.
15 Nakarai A, Kato J, Hiraoka S, et al. Prognosis of ulcerative colitis differs between patients with complete and partial mucosal healing, which can be predicted from the platelet count. World J Gastroenterol. 2014;20(48):18367-18374.
16 Akturk S, Buyukavci R. Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia. Clin Rheumatol. 2017;36(8):1885-1889.
17 Michalak A, Cichoz-Lach H, Guz M, Kozicka J, Cybulski M, Jeleniewicz W. Plateletcrit and Mean Platelet Volume in the Evaluation of Alcoholic Liver Cirrhosis and Nonalcoholic Fatty Liver Disease Patients. Biomed Res Int. 2021;2021:8867985.
18 Liang QC, Jin D, Li Y, Wang RT. Mean platelet volume and platelet distribution width in vascular dementia and Alzheimer's disease. Platelets. 2014;25(6):433-438.
19 Ozturk ZA, Dag MS, Kuyumcu ME, et al. Could platelet indices be new biomarkers for inflammatory bowel diseases? Eur Rev Med Pharmacol Sci. 2013;17(3):334-341.
20 Ebrahimi S, Gargari BP, Aliasghari F, Asjodi F, Izadi A. Ramadan fasting improves liver function and total cholesterol in patients with nonalcoholic fatty liver disease. Int J Vitam Nutr Res. 2020;90(1-2):95-102.
21 Scarpa M, Romanato G, Manzato E, et al. Restorative proctocolectomy for ulcerative colitis: impact on lipid metabolism and adipose tissue and serum fatty acids. J Gastrointest Surg. 2008;12(2):279-287.
22 Xiao W, Yang Y, Shi J, Xu J, Zhu J, Wu Z. The diagnostic efficacy and predictive value of combined lipoprotein laboratory indexes for atherosclerosis. J Pak Med Assoc. 2020;70 [Special Issue](9):115-119.
23 Zhang X, Devlin HM, Smith B, et al. Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis. PLoS One. 2017;12(5):e0176436.
24 Arora NK, Arora S, Ahuja A, et al. Alpha 1 antitrypsin deficiency in children with chronic liver disease in North India. Indian Pediatr. 2010;47(12):1015-1023.
25 Vucelic B, Milicic D, Krznaric Z, et al. [Serum acute phase proteins for determining disease activity of ulcerative colitis and Crohn disease]. Acta Med Austriaca. 1991;18(4):100-105.
26 Soendergaard C, Nielsen OH, Seidelin JB, Kvist PH, Bjerrum JT. Alpha-1 antitrypsin and granulocyte colony-stimulating factor as serum biomarkers of disease severity in ulcerative colitis. Inflamm Bowel Dis. 2015;21(5):1077-1088.
27 Xiang JY, Ouyang Q, Li GD, Xiao NP. Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis. World J Gastroenterol. 2008;14(1):53-57.
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Dai C, Dong Z, Wang Y, Huang Y, Jiang M. Development and validation of a nomogram to predict non-response to 5-aminosalicylic acid in patients with ulcerative colitis. 9703/2023


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Publication history

Received: 02/05/2023

Accepted: 17/08/2023

Online First: 14/09/2023

Published: 04/03/2024

Article revision time: 97 days

Article Online First time: 135 days

Article editing time: 307 days


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