Outcome of patients with primary sclerosing cholangitis and ulcerative colitis undergoing colectomy

Table 1 Baseline characteristics data, laboratory tests and clinical outcomes of 104 patients with primary sclerosing cholangitis and ulcerative colitis who underwent colectomy

Patient characteristics1	Total (n = 104)	Patients who continued follow-up or developed primary endpoints (n = 78)
Baseline characteristics data
Age at colectomy (yr)	43 (30-53)	42 (28-52)
Gender, male	70 (67)	56 (72)
Race, Caucasian	98 (94)	76 (97)
Presence of advanced liver fibrosis at baseline	27 (32)	24 (39)
Mayo risk score at baseline	-0.05 (-0.7, 1.1)	-0.001 (-0.8, 1.4)
BMI (kg/m2)	25 (22.6, 28.6)	24.7 (22, 27.4)
Previous use of immunosuppressive drugs	38 (36.5)	29 (37)
History of receiving ursodeoxycholic acid	33 (31.7)	26 (33.3)
Diabetes mellitus or impaired glucose tolerance	7 (7)	6 (7.6)
History of current smoking	2 (2)	2 (2.6)
Indication for colectomy
Severe colonic inflammation	51 (49)	37 (47)
Colonic dysplasia	44 (42)	36 (46)
Bowel perforation	3 (2.8)	3 (3.8)
Other indications	6 (5.7)	2 (2.6)
Laboratory tests at baseline
ALT (< 40 U/L)	70 (43, 113)	73 (43, 135)
AST (< 40 U/L)	50 (30, 96)	55 (32, 100)
Albumin (g/dL)	3.9 (3.5, 4.2)	3.9 (3.5, 4.2)
Total bilirubin (mg/dL)	0.7 (0.5, 1.5)	0.8 (0.5, 1.9)
Direct bilirubin (mg/dL)	0.2 (0.1, 0.7)	0.3 (0.1, 0.9)
ALP (U/L)	359 (194, 657)	385 (197, 839)
Glucose (mg/dL)	93 (86, 106)	93.5 (86, 107)
Creatinine (mg/dL)	1.0 (0.9, 1.1)	1.0 (0.9, 1.1)
CA 19-9 (normal < 55 U/mL)	17.2 (8.8, 51)	16.8 (8.5, 51)
Platelet (× 109/L)	289 (201, 350)	289 (205, 351)
INR	1 (0.9, 1.1)	1 (0.9, 1.1)
Clinical outcomes at the end of follow-up
Undergoing Ileal pouch-anal anastomosis	78 (75)	58 (74)
Length of hospital stay (d)	7 (6, 11)	8 (5, 12)
New diagnosis of malignancy after colectomy	32 (30.8)	26 (33.4)
Colorectal cancer	19 (18.3)	13 (16.7)
Other malignancy	13 (12.5)	13 (16.7)
Pathological findings
Colonic inflammation	62 (60)	45 (57.7)
Presence of colonic dysplasia	24 (23)	21 (27)
Colon cancer	19 (18.3)	12 (15.4)
Post-operative general complications within 1 mo	36 (34.6)	34 (43.6)
Post-operative liver complications within 1 mo	9 (8.7)2	9 (11.5)
Results of follow-up
All-cause mortality	13 (12.5)	13 (16.7)
Liver transplantation	13 (12.5)	13 (16.7)
Continued follow-up	52 (50)	52 (66.6)
Lost to follow-up	13 (25.0)	-

¹Median (interquartile range; IQR) or n (%);

²Including worsening liver tests (n = 3), liver failure requiring liver transplantation (n = 2), acute cholangitis (n = 3) and right hepatic vein thrombosis with hepatic infarct (n = 1). BMI: Body mass index; ALT: Alanine transaminase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; CA 19-9: Cancer antigen 19-9.

Table 2 Nine patients with primary sclerosing cholangitis and ulcerative colitis who underwent colectomy had worsening liver tests postoperatively

Case, Sex	Age at colectomy (yr)	Presence of advanced liver fibrosis	Pathological findings in the colon	Blood loss requiring transfusion	Liver complications	Other complications	Length of stay (d)	Presence of primary endpoints	Duration of follow up (yr)
1, M	28	Yes	Moderate inflammation	No	Worsening liver tests	Abdominal pain, Dehydration	18	No	8.5
2, M	28	Yes	Transverse colon cancer grade 3/4 T3N2	Yes; 2 units	Worsening liver tests	High ileostomy output	15	Death; colon cancer metastasis to liver	1.2
3, F	52	Yes	Mild inflammation	No	Worsening liver tests	Delayed wound healing, Blood loss	8	Death; liver failure	0.3
4, M	32	No	Moderate inflammation	No	Acute cholangitis	None	9	Liver transplant	1.1
5, M	33	Yes	Moderate inflammation	No	Acute cholangitis	None	6	No	8.3
6, F	54	No	Mild inflammation	Yes; 6 units	Liver failure	Severe blood loss, shock	8	Liver transplant; liver failure	0.3
7, F	21	Yes	Necrotized distal ileum with perforation	Yes; 9 units	Liver failure	DIC, Respiratory failure, GI-bleeding	30	Death; liver failure	0.03 (12 d)
8, F	21	No	Moderate inflammation	Yes; 2 units	SMV and hepatic vein thrombosis	Anemia,	15	Death; liver failure	8
9, M	41	No	Moderate inflammation	No	Acute cholangitis	Wound infection	10	No	3.6

M: Male; F: Female; DIC: Disseminated intravascular coagulation; HCC: Hepatocellular carcinoma; SMV: Superior mesenteric vein.

Table 3 A comparison of the clinical characteristics of 78 patients with primary sclerosing cholangitis and ulcerative colitis who underwent colectomy categorized by the presence or absence of primary endpoints

Clinical characteristics1	Without primary endpoints (n = 52)	With primary endpoints (n = 26)	P value2
Gender, %female	11 (21)	11 (42)	0.052
Age at colectomy (yr)	38.7 (27.8, 51.6)	45.8 (29.4, 52)	0.40
Presence of advanced liver fibrosis	12 (23)	12 (46)	0.032
Pre-operative Mayo risk score	-0.1 (-0.9, 0.9)	1.3 (-0.2, 2.2)	0.012
Pre-operative MELD score	7 (6, 9)	14 (11, 18)	< 0.0012
History of anemia or blood loss requiring a post-operative blood transfusion within 1 mo	4 (7.7)	7 (27)	0.022
Post-operative liver complications within 1 mo	3 (5.8)	6 (23)	0.022
Length of hospital stay (d)	7 (5, 10)	9 (7, 15)	0.07
Hemoglobin (g/dL)	13.1 (11.9, 14.4)	10.8 (9.8, 13.1)	< 0.0012
Platelet count (× 109/L)	296 (247, 357)	244 (126, 337)	0.022
INR	0.9 (0.9, 1.0)	1.1 (1.1, 1.3)	< 0.0012
Total bilirubin (mg/dL)	0.7 (0.5, 1.3)	2.3 (0.6, 5.0)	0.0012
Direct bilirubin (mg/dL)	0.2 (0.1, 0.4)	0.9 (0.2, 3.5)	0.0022
ALP (U/L)	352 (180, 494)	709 (276, 1232)	0.0032
AST (U/L)	44 (31, 90)	80 (36, 129)	0.09
Albumin (g/dL)	4.1 (3.4, 4.3)	3.5 (3.3, 3.9)	< 0.0012
Duration of follow up from colectomy to the last follow-up (yr)	5.5 (3.8, 8.8)	2.6 (0.8, 5.6)	0.0072

¹Median [interquartile range (IQR)] or n (%);

²P value < 0.05 for primary sclerosing cholangitis patients with or without primary endpoints and those variables with a P value < 0.1 in a univariate analysis were included in the multivariate analysis. AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; MELD: Model for End-Stage Liver Disease.

Table 4 Multivariate analysis models showing the association between primary sclerosing cholangitis patients with ulcerative colitis who underwent colectomy and the primary endpoints

Multivariate analysis	P value	OR	95%CI
Model 11
Platelet (× 109/L)	0.030	0.991	0.98-0.999
Albumin (g/dL)	0.006	0.05	0.007-0.44
Model 22
Pre-operative Mayo risk score	0.390	1.2	0.77-1.97
Hemoglobin (g/dL)	0.010	0.6	0.45-0.91
Model 33
Pre-operative MELD score	0.090	18.6	0.6-567
Hemoglobin (g/dL)	0.090	0.03	0.001-1.9

¹Model 1, to avoid overestimation of the model, we excluded the Mayo risk score and the Model for End-Stage Liver Disease (MELD) score from model 1;

²Model 2, we included the Mayo risk score in the model and removed the individual variables used for Mayo risk score calculation;

³Model 3, we included the MELD score in the model and removed the individual variables used for MELD score calculation. P < 0.05, all variables with P < 0.1 in a univariate analysis were included in the multivariate analysis models.