Introduction
Ulcerative colitis (UC) is a chronic inflammatory disease of idiopathic origin, primarily affecting the large intestine, with a notably increasing incidence in China, making it a growing public health concern. This debilitating condition is marked by periods of relapsing and remitting mucosal inflammation. Notably, coagulation abnormalities have been identified in individuals suffering from UC. Studies show that inflammatory bowel disease (IBD) significantly elevates the risk of venous thromboembolism (VTE), with UC patients facing approximately 2–3 times the risk of VTE compared to healthy individuals, leading to considerable morbidity and mortality rates among UC patients.
Materials and Methods
Study Population
We conducted a retrospective analysis of the electronic medical records of patients with UC who were admitted to the Jiangsu Province Hospital of Chinese Medicine. The study involved 364 UC patients admitted between January 2018 and July 2022. UC diagnosis was established based on clinical presentation, endoscopic evaluations, and histopathological findings. We focused on adult patients whose demographic, clinical, and laboratory data were retrievable. Key coagulation parameters, including fibrinogen (FIB), fibrin degradation products (FDP), and D-dimer levels, were systematically recorded. Patients were excluded for various reasons including pregnancy and coexisting Crohn’s disease (CD).
Statistics
Continuous variables are presented as median and interquartile range (IQR). We employed the Mann-Whitney and Kruskal-Wallis tests to analyze differences between groups. Categorical variables are expressed as percentages, and statistical comparisons were performed using the chi-square test. Spearman’s correlation analysis was utilized to assess the relationships between the variables. Receiver operating characteristic (ROC) curves were generated to effectively distinguish between severe and non-severe UC.
Results
Characteristics of Participants
A total of 364 UC patients participated in this study, with a median age of 46 years (IQR 34–58), and an age range from 18 to 78 years. The sample comprised 201 males and 163 females. Among these patients, 183 (50.3%) had extensive colitis. A significant proportion, 76.9%, were on oral 5-aminosalicylic acid (5-ASA), with 14% receiving steroid treatment and roughly 6.8% on biologic agents. Blood tests revealed that the severe UC group exhibited increased white blood cell (WBC) and platelet (PLT) counts, while they had significantly lower hemoglobin levels.
Comparison of FIB, FDP, and D-Dimer in Different UC Activity
Based on the Truelove and Witts criteria, UC activity was categorized into mild (139 patients), moderate (145 patients), and severe (80 patients). Notable differences were observed in FDP, FIB, and D-dimer levels across these activity groups, with increases in all three parameters correlating with the severity of the disease.
ROC Analysis
ROC analysis assessed the predictive performance of coagulation parameters in discerning severe UC from non-severe cases. The area under the curve (AUC) for D-dimer was found to be 0.852 (95% CI, 0.805–0.898), with an optimal cut-off point determined at 0.585, yielding a sensitivity of 80.6% and specificity of 78.9%. Similarly, the AUC for FIB was 0.853 (95% CI, 0.807–0.9) while FDP had an AUC of 0.801 (95% CI, 0.741–0.862).
Discussion
The increased risk of thromboembolic events in UC patients has garnered significant attention in recent years. Consensus guidelines advocate for anticoagulant prophylaxis in severe UC cases. While biomarkers for evaluating UC severity continue to be studied, traditional markers like ESR and CRP offer reliable indications of disease activity but may lack optimal diagnostic performance. Our findings indicate that elevated FIB, FDP, and D-dimer levels are indicative of severe UC, potentially serving as useful biomarkers for monitoring disease activity.
Limitations of this study included its retrospective nature and the reliance on electronic medical records, which introduce inherent biases. The relatively small sample size limits the generalizability of our findings. Additionally, the lack of data on extraneous factors such as surgical history, central venous catheter use, smoking habits, and use of oral contraceptives further constrains the scope of our analysis.
This research emphasizes the potential of FIB, FDP, and D-dimer levels in distinguishing between severe and non-severe forms of UC, thereby highlighting their utility as biomarkers for ongoing disease activity monitoring. Future prospective investigations are imperative to further elucidate the characteristics of coagulation changes in UC patients.
Ethics Approval and Consent to Participate
The study protocol received ethical approval from the Ethics Committee of the Affiliated Hospital of Nanjing TCM University, with informed consent waived due to the retrospective nature of the study. Patient data confidentiality was strictly maintained in compliance with the Declaration of Helsinki throughout the research period.
Funding
This study was financially supported by the National Natural Science Foundation of China (grant number: 82305158).
Disclosure
The authors confidently declare no competing interests regarding this study.
References
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6. Yuhara H, Steinmaus C, Corley D, et al. Meta‐analysis: the risk of venous thromboembolism in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;37:953–962. doi:10.1111/apt.12294
19. Feuerstein JD, Isaacs KL, Schneider Y, et al. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2020;158:1450–1461. doi:10.1053/j.gastro.2020.01.006
21. Nguyen GC, Bernstein CN, Bitton A, et al. Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian Association of Gastroenterology. Gastroenterology. 2014;146:835–848.e6. doi:10.1053/j.gastro.2014.01.042
38. Sarlos P, Szemes K, Hegyi P, et al. Steroid but not biological therapy elevates the risk of venous thromboembolic events in inflammatory bowel disease: a meta-analysis. J Crohn’s Colitis. 2018;12:489–498. doi:10.1093/ecco-jcc/jjx162
Introduction
So, let’s dive deep into the delightful world of ulcerative colitis (UC). It’s like the fancy French restaurant of digestive diseases: exclusive, a bit snobby, and guaranteed to leave you with a hefty bill—of discomfort! UC, the chronic inflammatory disease taking a sly jab at your large intestine, has decided to play a starring role in China lately, stealing the spotlight like a C-list celebrity crashing a red carpet event. This party is characterized by its relapsing and remitting nature, making it a bit like that friend who keeps ghosting you but then suddenly shows up with drama. Hot tip: if any of your organs start complaining, you might just want to kick them out!
The scientific crowd has been busy reading up on coagulation abnormalities found in UC patients. Who knew our blood had its own drama? Inflammatory bowel disease—a fancy term for this whole mess—comes with its own set of risks, especially the high chance of venous thromboembolism (let’s just call it VTE, shall we?). The unfortunate truth? IBD patients have a 2-3 times greater risk of experiencing VTE compared to your average Joe. So, with all this morbidity and mortality floating around, the stakes just got higher in the game of UC-related health challenges!
Materials and Methods
Study Population
Let’s talk numbers, shall we? We peered into the electronic medical records, where all the dirt is kept, of 364 UC warriors who ended up at the Jiangsu Province Hospital of Chinese Medicine between January 2018 and July 2022. Inclusion criteria? Adult patients with a flair for demographic, clinical, and laboratory data—we’re not just Googling here, folks! We’re digging deep—any exclusions? Oh, the classic: pregnancy, Crohn’s disease, and other inflammatory fancy pants disorders are all barred from this exclusive club.
Disease Activity
We’re throwing around the term “Truelove and Witts criteria,” not because we’re in a rom-com, but to classify our patient’s disease activity into mild, moderate, and severe. It requires a bit of heart rate, temperature, and good old stool-checking. This is scientific evaluation at its finest, not your grandmother’s bingo night!
Statistics
We crunched numbers like there was no tomorrow. Continuous variables are presented as median and interquartile range—a fancy way of saying we took the average but made it sound more sophisticated. That’s right, Mann–Whitney and Kruskal-Wallis tests were put to Good Use; you’ll find we don’t mess around when it comes to numbers!
Results
Characteristics of Participants
We gathered all 364 participants like a stockpiling squirrel. Don’t think this is just some boring academic subplot; the median age was a spry 46, with both males and females strutting in. Among the findings? A whopping 76.9% were on oral 5-aminosalicylic acid (5-ASA)—basically the hip choice for those battling UC.
Comparison of FIB, FDP, and D-Dimer in Different UC Activity
Now, you may be wondering, “What about the FIB, FDP, and D-Dimer levels?” Glad you asked! As we marched from mild to severe disease activity, we saw those nasty numbers gloriously rise. Imagine escalation of drama, but in the bloodstream.
Comparison of FIB, FDP, and D-Dimer Between Severe and Non-Severe UC
Diving into the data, we found severe UC patients clutching a D-dimer level like a golden ticket: significantly higher than their non-severe counterparts. Talk about mopping the floor with the competition!
Comparison of FIB, FDP and D-Dimer Levels According to Disease Extent
Classification isn’t just for high school cliques. In our cohort, around 50% flaunted pancolitis, the heavyweight champ of UC. And what did we find? Yep, pancolitis ruled the roost with higher D-dimer levels over other forms of colitis. #DramaQueen
Correlation Analysis
We established the correlative ties between FIB levels and ESR, because when it comes to patients with UC, correlation is the name of the game, and boy, is it a wild ride!
ROC Analysis
Finally, the pièce de résistance: the ROC analysis! D-dimer strutting its stuff with an AUC of 0.852, while FIB flexed at 0.853. If these metrics were a personality type, they’d be the overachievers of the research world, proudly stating, “Look at us; we can differentiate severe from non-severe UC.”
Discussion
Let’s get serious now; the potential for thromboembolic events in UC isn’t a laughing matter. Healthcare professionals have been working hard to recommend anticoagulant prophylaxis for severe patients. But, while biomarkers like ESR and CRP are reliable, they’re still not acing the diagnostic performance test. As we highlighted, coagulation parameters like FIB, D-dimer, and FDP are stepping into the limelight, looking to take some credit for their roles as potential biomarkers. Who knew blood could have such talent?
Yet, we must tread carefully. The research shows a mixed bag when it comes to these parameters. Some studies champion FIB while others keep it humble—you know the type. Not every study agrees, but our findings add to the chorus of evolving understandings about the interplay of UC and coagulation.
So there we have it—a nuanced tapestry woven with data, dramatic anecdotes, and a pinch of humor. Like UC itself, our discussion is not done yet; further studies are needed to better understand how coagulation parameters can aid patient care. Oh, and don’t forget—we still need to check on those confounding factors that could skew the results. After all, not everything in UC is straightforward.
Ethics Approval and Consent to Participate
The study protocol received the green light from the Ethics Committee of the Affiliated Hospital of Nanjing TCM University. Informed consent? Waived, owing to our retrospective design. By the way, we also ensured patient data confidentiality and played nice with the Declaration of Helsinki. Because what’s a good study without that, right?
Funding
This enlightening escapade into medical inquiry was supported by the National Natural Science Foundation of China, grant number: 82305158. We like to joke that someone’s got to foot the bill, so we’re glad they did!
Disclosure
The authors swear on their pet goldfish that they have no competing interests. Human drama? Yes! Financial drama? Absolutely not!
References
Here, we assemble the titans of past research, all of whom provided foundational knowledge for our discussion. So, hats off to them! You can comb through the references—all filled with complex jargon and acronyms, ideal for those cozy winter evenings in with a hot cup of tea (or coffee, or whatever you prefer). Trust us, it’s a page-turner.
This article is written with a conversational yet sharp tone to engage readers and make a complex topic like ulcerative colitis approachable while maintaining substantial informational value.
What are the key coagulation factors associated with increased thromboembolic risk in patients with ulcerative colitis, and how might these be monitored for improved patient outcomes?
, and clinical implications. The reality is that while ulcerative colitis poses significant risks for thromboembolic events, ongoing investigation into coagulation factors is crucial. As we refine our understanding of these relationships, we can potentially improve patient outcomes through tailored risk management.
the world of ulcerative colitis is complex, yet exciting. Our results suggest that monitoring coagulation parameters like FIB, D-dimer, and FDP may provide valuable insights into the severity of the disease and help in guiding treatment strategies. Just like a fine French meal, understanding UC requires a delicate balance of ingredients—each factor plays a role in the overarching narrative of patient health. Armed with this knowledge, healthcare providers can better navigate the tumultuous waters of ulcerative colitis management, ensuring that patients receive the most comprehensive care possible.
Now, let’s keep the conversation going on how to transform these findings into real-world application—after all, the ultimate goal is a healthier, happier UC patient.