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Serum Procalcitonin as a Potential Early Predictor of Short-Term Outcomes in Acute Severe Ulcerative Colitis

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Abstract

Background

Delayed colectomy can be life-threatening for patients with acute severe ulcerative colitis (ASUC). However, few biomarkers can predict the outcomes of ASUC patients before treatment. Serum procalcitonin (PCT) has been observed to be increased in ASUC patients.

Aim

The aim of this study was to estimate the association between serum PCT and short-term outcomes in patients with ASUC.

Methods

A single-center observational study was conducted at a referral hospital from January 2012 to January 2018. Hospitalized ASUC patients, who were administered intravenous corticosteroids (IVCS), were enrolled and followed up for 6 months. The primary outcome was IVCS failure; the secondary outcome was colectomy. Relationships between indicators and clinical outcomes were assessed.

Results

Of 152 ASUC patients enrolled in this study, 81 responded to IVCS and 71 failed (62 required short-term colectomy and 9 responded to second-line rescue therapy). Serum PCT on admission was significantly higher in IVCS-failure cases and surgical cases than in medical responders. Serum PCT ≥ 0.10 µg/L (OR = 4.134, p = 0.001) predicted IVCS failure with specificity of 0.741, and the combined measurement with fecal calprotectin (FC) ≥ 1500 µg/g improved the sensitivity. Serum PCT correlated significantly with the Ulcerative Colitis Endoscopic Index of Severity (r = 0.416, p < 0.001) and FC (r = 0.384, p < 0.001).

Conclusion

Serum PCT on admission could be a potential early non-invasive predictive biomarker for IVCS failure in ASUC patients, and a combination of PCT and FC could improve the predictive value.

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Abbreviations

Alb:

Albumin

ASUC:

Acute severe ulcerative colitis

CRP:

C-reactive protein

ESR:

Erythrocyte sedimentation rate

FC:

Fecal calprotectin

Hb:

Hemoglobin

IVCS:

Intravenous corticosteroids

MODS:

Multiple organ dysfunction syndrome

PCT:

Procalcitonin

UCEIS:

Ulcerative Colitis Endoscopic Index of Severity

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Acknowledgments

We would like to thank Dr. Xiaowei Wu at Jinling Hospital for his critical reading of the manuscript.

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81570506).

Author information

Author notes

  1. Hui-min Wu and Juan Wei contributed equally to this paper.

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Zhongshan East Road 305, Nanjing, 210002, China

    Hui-min Wu, Lei Ye, Ying Qi, Bo-si Yuan, Yu-lin Yang, Zhao Yang, Miao-fang Yang & Fang-yu Wang

  2. Department of Gastroenterology and Hepatology, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, China

    Juan Wei & Fang-yu Wang

  3. Bengbu Medical College, Bengbu, China

    Jin Li & Li Zhao

  4. Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China

    Kai Wang & Jian-feng Gong

Authors
  1. Hui-min Wu
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Contributions

HW, JW, and FW contributed to the conception and design of this study. HW, JL, KW, BY, and LZ made substantial contributions to data acquisition. HW, KW, YQ, LY, and YY contributed to data analysis, data interpretation, and drafting of the manuscript. HW, ZY, MY, JG, and FW contributed to revision and proofreading of the manuscript. All authors had full access to all the data in the study and agreed with this submission.

Corresponding author

Correspondence to Fang-yu Wang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical consideration

This study complied with the principles of the Declaration of Helsinki. Patients were informed of the design of this study and were given the opportunity to refuse participation. The study was approved by the ethics committee of Jinling Hospital and was registered in ClinicalTrials.gov (NCT03578692).

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Wu, Hm., Wei, J., Li, J. et al. Serum Procalcitonin as a Potential Early Predictor of Short-Term Outcomes in Acute Severe Ulcerative Colitis. Dig Dis Sci 64, 3263–3273 (2019). https://doi.org/10.1007/s10620-018-5446-0

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