P304 Leucine-rich alpha 2 glycoprotein reduces the necessity for endoscopic examination for activity evaluation
HayashiHayasix@0917, T.(1)*;Takatori, H.(1);Yamashita, T.(1);
(1)Kanazawa University, IBD center, Kanazawa- Ishikawa, Japan;
Background
Leucine-rich alpha 2 glycoprotein (LRG) reflects mucosal healing in ulcerative colitis (UC) and is useful for assessing mucosal healing. In this study, we hypothesized that endoscopy for activity evaluation may be unnecessary depending on LRG levels, and investigated the relationship between LRG and endoscopic findings.
Methods
Patients who underwent endoscopy for UC from April 2021 to August 2022, when LRG measurement became available, and whose LRG was measured within a month, were included in the study. The relationship between Mayo endoscopic subscore (MES) and LRG was evaluated and symptoms were also reviewed to examine these relationships. Endoscopic remission was defined as MES 1 or less.
Results
The mean (range) LRG values per MES and the percentage of patients with a cutoff value of less than 16 μg/mL were MES 0 (n=86): 11.3±2.8 (6.0-24.2) μg/mL, 96.5%; MES 1 (n=56): 13.3±6.0 (7.7-43.8) μg/mL, 79.2%; MES 2(n=53): 21.7±11.5(8.1~65.1) μg/mL, 34.0%, MES 3(n=19): 26.4±9.3(12.3~42.9) μg/mL, 25.0%, and AUC 0.856 in ROC analysis, higher than other markers (CRP, Alb, WBC) LRG Even below the cutoff value, 15.0% (22/147) were in endoscopic non-remission. Even when patients have neither diarrhea 3 or more times a day nor bloody stool, 7.4% (9/122) were still in endoscopic non-remission. However, there were no cases in endoscopic non-remission when the LRG was below the cutoff value and there were no such symptoms. In multivariate analysis using binomial logistic regression analysis, LRG (p=0.028) was an independent predictor of endoscopic remission, in addition to diarrhea (p=0.003) and bloody stool (p<0.001).
Conclusion
LRG was a useful tool for predicting endoscopic activity in ulcerative colitis, but LRG alone could not exclude non-remitting cases. However, LRG was considered to be an independent predictor of endoscopic remission, and all patients who had less than the LRG cutoff value and no diarrhea or bloody stool more than 3 times a day showed endoscopic remission, suggesting that endoscopy for activity evaluation may be unnecessary in such cases.