P356 CRAB Score, An Indian Insight into in hospital and long-term Colectomy following Acute Severe Ulcerative Colitis (ASUC)
(1)Consultant Gastroenterologist and former senior Resident, Medical Gastroenterology, Alappuzha, India;
Oxford and Swedish index were developed to predict in hospital colectomy in ASUC and not for long-term prediction say one to two years. Oxford index, Swedish index and other predictors of Colectomy are based on western Data. In hospital colectomy rates were also rapidly decreasing during the last two decades with the advent of rescue therapy like infliximab and cyclosporine but the colectomy rate within one or two years of ASUC is not significantly reduced. Study by Alice et al had shown that with advent of infliximab and cyclosporine rescue therapy oxford index no longer predicts in-hospital colectomy rates also in addition to its shortcoming in predicting long-term colectomy rates. Our study Aims to find out the predictors of in hospital and long-term colectomy in an Indian cohort of ASUC patients.
Prospective observational study conducted in department of Medical Gastroenterology medical college Trivandrum over a period of 5 years (2015-2020). ASUC is defined by Truelove Witts criteria Patients with ASUC were followed up for a period of 24 months to look for progression to colectomy.
Total 81 patients were taken up for the study (47 males and 34 females). 15 patients progress to colectomy during the follow up period of 24 months (11 patients had colectomy done during the same hospital admission and 4 patients during the follow up period of 24 months). Among the variables analysed Albumin, CRP and Hb were significant in predicting colectomy in 24 months. On regression analysis CRP and Albumin were independent predictors of 24-month colectomy and coefficient of Beta was multiplied to albumin and CRP and total score was obtained and termed it as CRAB (CRP + Albumin) score (CRAB score = CRP*0.2 – Albumin*0.26). This score was plotted to AUROC and the score has AUROC of 0.923 and at a Score of >0.4 has sensitivity of 82 and specificity of 92% 24-month chance for colectomy following ASUC. The score was validated in a validation cohort of 31 patients and in validation cohort also at >0.4 the score has sensitivity of 83 and specificity of 96% in predicting colectomy. Those without pancolitis and those with a precipitating factor for colitis exacerbation won’t progress to Colectomy.
CRAB score is a simple prognostic score that can predict 24-month colectomy in ASUC patients with high sensitivity and specificity. Those without pancolitis and those with a precipitating factor for colitis exacerbation won’t progress to Colectomy.