The Importance of Sarcopenia as a Prognostic Marker for Clinical Course and Postoperative Outcomes in Acute Severe Ulcerative Colitis Patients

Abstract

Background: Acute severe ulcerative colitis (ASUC) is a life-threatening condition, which needs timely referral for first-line and second-line therapy. Although various clinical parameters for predicting response to intravenous steroid (IVS), rescue medical therapy, or colectomy and for evaluating postoperative outcomes already exist, there is few data concerning the role of sarcopenia in ASUC. The relationship between sarcopenia and clinical course in ASUC was evaluated in this study. Methods: This cohort study included ASUC patients with abdominal CT scan. Quantification of body composition was assessed. Multivariable regression was performed to find out a practical predictive index for clinical course and colectomy of ASUC. Findings: Of 233 included patients, 151 showed nil response to IVS therapy, among whom 32 received surgery without rescue medical therapy. 50 patients suffered colectomy after medical rescue therapy failure during one-year follow-up. Of 82 surgical patients, 42 recovered eventfully. Multivariable regression analysis showed sarcopenia (OR=2.962; 95% CI, 1.532-5.726; p=0.001) remained an independent risk factor for IVS failure, subcutaneous fat areas (OR=0.985; 95% CI, 0.970-1.000; p=0.046) was an independent predictor for colectomy during one year after second-line medical failure, and sarcopenia (OR, 4.157; 95% CI, 1.364-12.667; p=0.012) remained an independent risk factor for postoperative complications. During follow-up, patients with colectomy after first-line medical had higher health-related quality of life and sarcopenic patients suffered the pouchitis more frequently. Interpretation: The sarcopenia was superior to other common indicators in predicting clinical course and postoperative outcomes in ASUC. Funding Statement: This work was supported by National Natural Science Foundation of China (grant number 81800474). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This cohort study was approved by the Ethics Committee of Medical School of Zhejiang University, China.