Article Text

Download PDFPDF

28 Visceral pseudo-obstruction (VPO): a new terminology of systemic lupus erythematosus gastrointestinal involvement and a CT scoring system
Free
  1. Zhiwei Chen,
  2. Jiaoyu Li,
  3. Xiaodong Wang,
  4. Ting Li and
  5. Shuang Ye
  1. South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University

Abstract

Background To identify the relevant parameters for SLE-VPO evaluation on computed tomography (CT), and try to develop a CT image based evaluation system for SLE-VPO.

Methods Patients with SLE gastrointestinal involvement from two independent retrospective cohorts were included in our study. All patients fulfilled the ACR 1997 revised classification criteria for SLE. CT scan at least once is necessary prior to glucocorticoid treatment in all enrolled patients. The primary endpoint was set to time to GI functional recovery, defined as intake 50% ideal calories POPO50. A new CT scoring system for SLE-VPO was established in the derivation cohort and validated in the validation cohort.

Results A total of 90 and 47 patients with SLE gastrointestinal involvement were enrolled in the derivation cohort and the validation cohort, respectively. The time to PO50 was significantly correlated with extent of anatomical involvementP ≤0.0015 and thickness of the intestinal wallP=0.0008 in the derivation cohort. A CT scoring system was developed with the combination of extent of anatomical involvement and thickness of the intestinal wall. CT score for VPO was positively correlated with patients time to PO50 (r=0.47, p<0.0001 in derivation cohort, r=0.44, p=0.0018 in validation cohort), and to a lesser extent correlated with the length of hospital stay (r=0.27, p=0.01 in derivation cohort, r=0.21, p=0.1577 in validation cohort). Patients with a CT score ≤2 tend to have a more rapid reversible course with an average time to PO50 of 5.72 and 7.44 days in the derivation cohort and the validation cohort, respectively; while patients with a CT score >2 have a significantly prolonged recovery with an average time to PO50 of 14.55 (p<0.0001) and 18.45 (p=0.0064) days, respectively. More TPN was prescribed in the high CT score group in both cohorts (74.47% vs 51.16%, p=0.0289 in the derivation cohort; 80% vs 40.74%, p=0.0089 in the validation cohort). And the proportions of patients underwent TPN ≥7 days were also much higher in the high CT score group in both cohorts (p<0.05).

Abstract 28 Figure 1

Anatomical distribution of SLE-VPO involvement.

Abstract 28 Figure 2

CT scoring system and illustration. A CT image based scoring system was developed, taken into consideration of both the extent of VPO multi-compartment involvement and the severity of intestinal wall thickness(a). Give an example of how to perform CT scoring (b-d), c: arrow refers to ureterohydronephrosis (1-point) and intestinal edema (8.4 mm, 2-point); d: arrow refers to colonic edema (10.2 mm, 2-point). The patient had a CT score of 5 points and the time to PO50 was 49 days. The measurements of gastric and rectum wall thickness are excluded from the scoring system to avoid food/fecal contents-induced inaccuracy. Thickness of bowel walls refers to the thickest bowel wall measured of each GI segment. Bile-pancreatic system involvement includes gallbladder edema, bile duct dilatation, pancreatic duct dilatation, pancreatic edema/exudation without mechanical obstruction. Urinary system involvement includes ureterohydronephrosis and interstitial cystitis without mechanical obstruction.

Abstract 28 Figure 3

CT scores predict GI functional outcome. CT score for VPO is positively correlated with patients’ time to PO50 (r=0.47, p<0.0001 in derivation cohort, r=0.44, P=0.0018 in validation cohort, a-b). CT score for VPO is lesser extent correlated with the length of hospital stay (r=0.27, p=0.01 in derivation cohort, r=0.21, P=0.1577 in validation cohort, c-d). Patients with a CT score ≤2 tend to have a more rapid reversible course with an average time to PO50 of 5.72 and 7.44 days in the derivation cohort and the validation cohort, respectively; while patients with a CT score >2 have a significantly prolonged recovery with an average time to PO50 of 14.55 (p<0.0001) and 18.45 (P=0.0064) days, respectively (e). Kaplan-Meier curve presenting the cumulative percent of patients not reaching PO50 with different CT scores over the follow-up period (P=0.0002 in derivation cohort, f; P=0.134 in validation cohort, g; P=0.0018 in pooled cohort, h). Comparison was performed using log-rank (Mantel-Cox) test

Abstract 28 Figure 4

A flow chart of SLE-VPO dietary recovery and TPN use based on CT scoring system

Conclusions The terminology of VPO and a CT-based scoring system may facilitate more accurate assessment and individualized management for SLE patients with GI involvement. It also meant to be helpful in terms of future clinical trial design and in-depth mechanistic research for this unique complication of lupus.

Funding Source(s): This work was supported by the National key research and development program of China (2017YFC0909002), the National Key Research and Development Program of China(2016YFC0903900).

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.