Fernando Magro1,2, Joanne Lopes3, Paula Borralho4, Cláudia Camila Dias5,6, Joana Afonso2,7, Paula Ministro8, Mafalda Santiago6, Karel Geboes9, Fátima Carneiro3,10,11. 1. Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal. 2. Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal. 3. Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal. 4. Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal. 5. Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal. 6. CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal. 7. MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal. 8. Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal. 9. Department of Pathology, University Hospital of KU Leuven and UZ Ghent, Leuven, Belgium. 10. Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup], University of Porto, Porto, Portugal. 11. Institute of Research and Innovation in Health [i3S], University of Porto, Porto, Portugal.
Abstract
BACKGROUND AND AIMS: Evidence has been supporting that histological activity of ulcerative colitis [UC] has relevance for the prediction of clinical outcomes in UC patients, such as clinical relapse. In this study, we aimed to compare two histological indexes-the continuous Geboes score [GS] and the Nancy index [NI] -regarding their definitions of histological remission and response, and to determine the ability of faecal calprotectin [FC] levels to discriminate between these histological statuses according to the NI. METHODS: A large cohort of UC patients [N = 422] who were previously enrolled in other studies was analysed. RESULTS: GS and NI were shown to be strongly correlated [correlation coefficient: 0.882, p <0.001], indicating high accordance in the classification of patients as having/not having histological remission and response. FC levels moderately correlated with NI regarding these histological statuses [correlation coefficient: 0.481, p <0.001], moderately predicted the absence of remission defined by NI >0 {area under the curve (AUC) 0.667 (95% confidence interval [CI] 0.609-0.724)}, and were good predictors of the absence of histological response defined by NI >1 (AUC 0.825 [95% CI 0.777-0.872]). The optimal FC cut-offs determined to predict the NI-defined histological remission and response were 91 μg/g and 106 μg/g, when maximising the negative predictive value [NPV]. CONCLUSIONS: Due to the higher applicability of the NI, this study encourages the systematic use of this histological index to assess histological remission and response in UC patients.
BACKGROUND AND AIMS: Evidence has been supporting that histological activity of ulcerative colitis [UC] has relevance for the prediction of clinical outcomes in UC patients, such as clinical relapse. In this study, we aimed to compare two histological indexes-the continuous Geboes score [GS] and the Nancy index [NI] -regarding their definitions of histological remission and response, and to determine the ability of faecal calprotectin [FC] levels to discriminate between these histological statuses according to the NI. METHODS: A large cohort of UC patients [N = 422] who were previously enrolled in other studies was analysed. RESULTS:GS and NI were shown to be strongly correlated [correlation coefficient: 0.882, p <0.001], indicating high accordance in the classification of patients as having/not having histological remission and response. FC levels moderately correlated with NI regarding these histological statuses [correlation coefficient: 0.481, p <0.001], moderately predicted the absence of remission defined by NI >0 {area under the curve (AUC) 0.667 (95% confidence interval [CI] 0.609-0.724)}, and were good predictors of the absence of histological response defined by NI >1 (AUC 0.825 [95% CI 0.777-0.872]). The optimal FC cut-offs determined to predict the NI-defined histological remission and response were 91 μg/g and 106 μg/g, when maximising the negative predictive value [NPV]. CONCLUSIONS: Due to the higher applicability of the NI, this study encourages the systematic use of this histological index to assess histological remission and response in UC patients.