High Serum Osmolality May Predict the Disease Severity in Patients with Acute Ulcerative Colitis

Abstract

Objective: Ulcerative colitis (UC) is characterised by chronic immun- mediated inflammation of the colonic mucosa. The Truelove and Witts (TW) criteria have been used to define the severity of the UC. Otherhand, a simplier and unified laboratory tool is needed for better definition of high risk patients with UC. The aim of the study, especially in emergency service applications, was to determine the usefulness of serum osmalality as a biomarker which can easily and rapidly predict the severity of the disease, in which the patient will be advised to be hospitalized after the symptomatic treatment. 

Materials and Methods: In this single-center, retrospective cohort study, we collected data of 62 hospitalized patients with UC such as demographic characteristics and blood sample results evaluated by clinicians. Truelove and Witts (TW) scores of the patients along with serum osmolality were calculated. Stata 14.0. package program was used for data analysis. P <0.05 was considered statistically significant. 

Results: According to our results, patients with hyperosmolality were more likely to have severe UC as defined by having higher scores of TW criteria at baseline.

Conclusion: As a conclusion, serum osmolality can be considered as an useful predictor to demonstrate the severity of the disease.

Keywords

• Acute ulcerative colitis,serum osmolality,Truelove Witt’s score

Yüksek Serum Osmolalitesi Akut Ülseratif Kolit Hastalarında Hastalık Şiddetini Tahmin Edebilir

Öz

Amaç: Ülseratif kolit (ÜK), kolon mukozasının kronik immün aracılı enflamasyonu ile karakterizedir. ÜK’nin ciddiyetini tanımlamak için Truelove ve Witts (TW) kriterleri kullanılmıştır. Diğer taraftan, ÜK’li yüksek riskli hastaların daha iyi tanımlanabilmesi için daha basit bir laboratuvar aracına ihtiyaç vardır. Çalışmanın amacı, özellikle acil servis uygulamalarında, hastanın semptomatik tedaviden sonra hastaneye yatırılması gerekliliğini öngörebilen ve hastalığın ciddiyetini kolayca ve hızlı bir şekilde tahmin edebilen bir biyobelirteç olarak serum osmalalitesinin yararlılığını belirlemektir. 

Materyal ve Metot: Bu tek merkezli, retrospektif kohort çalışmasında ÜK’li 62 hastanın demografik özellikleri ve kan örnek sonuçları değerlendirildi ve veriler toplandı. Serum osmolalitesi ile birlikte hastaların Truelove ve Witts (TW) skorları hesaplandı. Data analizinde stata 14.0. paket programı kullanıldı. P < 0,05 istatiksel olarak anlamlı kabul edildi. 

Bulgular: Çalışma sonunda, yüksek osmolaliteli hastaların daha yüksek olasılıkla şiddetli ülseratif kolite, yüksek TW skoru, sahip oldukları görülmüştür.

Sonuç: Sonuç olarak, serum osmolalitesi hastalığın ciddiyetini göstermek için yararlı bir belirleyici olarak düşünülebilir.

Anahtar Kelimeler

• Akut ülseratif kolit,serum ozmolalitesi,Truelove Witt’s skoru

References

1. 1. Dulai PS, Jairath V. Acute severe ulcerative colitis: latest evidence and therapeutic implications. Ther Adv Chronic Dis. 2018;9(2):65-72.
2. 2. Danese S, Banerjee R, Cummings JF et al. Consensus recommendations for patient-centered therapy in mild-to-moderate ulcerative colitis: the i Support Therapy-Access to Rapid Treatment (iSTART) approach. Intest Res. 2018;16(4):522-528.
3. 3. Truelove SC, Witts LJ. Cortisone in ulcerative colitis; preliminary report on a therapeutic trial. Br Med J. 1954;2:375-378.
4. 4. Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60:571-607.
5. 5. Brown SR, Haboubi N, Hampton J, George B, Travis SP. ACPGBI. The management of acute severe colitis: ACPGBI position statement. Colorectal Dis. 2008;10(Suppl 3):8-29.
6. 6. Jain S, Kedia S, Bopanna S. et al. Are Truelove and Witts criteria for diagnosing acute severe colitis relevant for the Indian population? A prospective study. Intest Res. 2018;16(1):69-74.
7. 7. Vaduganathan M, Marti CN, Mentz RJ, Serum Osmolality and Postdischarge Outcomes After Hospitalization for Heart Failure. Am J Cardiol. 2016;117(7):1144-1150.
8. 8. Liamis G, Filippatos TD, Liontos A, Elisaf M1. Serum osmolal gap in clinical practice: usefulness and limitations. Postgrad Med. 2017;129(4):456-459.

9. 9. Rasouli M. Basic concepts and practical equations on osmolality: Biochemical approach. Clin Biochem. 2016;49(12):936-941.
10. 10. Heavens KR, Kenefick RW, Caruso EM, et al. Validation of equations used to predict plasma osmolality in a healthy adult cohort. Am J Clin Nutr. 2014;100:1252-1256.
11. 11. Wannamethee SG, Shaper AG, Lennon L, et al. Mild hyponatremia, hypernatremia and incident cardiovascular disease and mortality in older men: a population-based cohort study. Nutrition, Metabolism and Cardiovascular Diseases. 2016;26:12-19.
12. 12. Xie J, Cui K, Hao H, et al. Acute hyperglycemia suppresses left ventricular diastolic function and inhibits autophagic flux in mice under prohypertrophic stimulation. Cardiovasc Diabetol. 2016;15:136
13. 13. Shen Y, Cheng X, Ying M et al. Association between serum osmolarity and mortality in patients who are critically ill: a retrospective cohort study. BMJ Open. 2017;7(5):e015729.
14. 14. Brian MS, Matthews EL, Watso JC, et al. The influence of acute elevations in plasma osmolality and serum sodium on sympathetic outflow and blood pressure responses to exercise. J Neurophysiol. 2018;119(4):1257-1265.
15. 15. Zhang M, Sun K, Wu Y, Yang Y, Tso P2, Wu Z. Interactions between Intestinal Microbiota and Host Immune Response in Inflammatory Bowel Disease. Front Immunol. 2017;8:942.
16. 16. Hindryckx P, Jairath V, D'Haens G. Acute severe ulcerative colitis: from pathophysiology to clinical management. Nat Rev Gastroenterol Hepatol. 2016;13(11):654-664.
17. 17. Archampong EQ, Harris J, Clark CG. The absorption and secretion of water and electrolytes across the healthy and the diseased human colonic mucosa measured in vitro. Gut. 1972;13(11):880-886.