ASC is a life-threatening medical emergency. The lack of a timely intervention has shown to be associated with a mortality rate higher than 20% in adults, whereas a prompt targeted therapy has displayed a decrease of the aforementioned rate to 1%. Therefore, the identification of predictors of poor outcome trough an objective tool may provide crucial help to individualize the timing of second line treatment initiation. At the state of the art, PUCAI represents the only validated tool to appraise the risk of first-line treatment failure and there is a lack of objective methods with a prognostic value in ASC. BUS has proven to be a reliable tool in assessing disease activity in children with UC and it has also shown statistically significant correlation with endoscopic features of disease activity. Given the literature suggesting a role for BUS in severe UC and the results from our retrospective study we aim to validate our findings trough a prospective assessment of the potential prognostic role of BUS in ASC.
Study Type
OBSERVATIONAL
Enrollment
120
Meyer Children's Hospital IRCCS
Florence, Firenze, Italy
RECRUITINGOspedale Maggiore
Bologna, Italy
RECRUITINGIRCCS Materno Infantile Burlo Garofolo
Trieste, Italy
RECRUITINGCMED Centro Médico-Quirúrgico de Enfermedades Digestivas
Madrid, Spain
RECRUITINGColonic wall thickness of BUS (bowel ultrasound) parameter to predict the failure of first line treatment
Investigation of the ability of BUS (bowel ultrasound) parameters, such as Colonic wall thickness (CWT) measured in mm, assessed within 48 hours from i.v. steroid treatment initiation, to predict the failure of first line treatment (defined according to the latest ESPGHAN guidelines). CWT will be measured from the edge of the outer wall to the inner echogenic lumen, containing air, or to the central echogenic mucosal stripe. CWT will be assessed as follows: two measurement through longitudinal plain and two through tranverse plain will be performed and the mean value (the sum of each measurement divided for 4) will be taken into account
Time frame: Within 48 hours from i.v. steroid treatment initiation
Color and power Doppler vascularization of BUS (bowel ultrasound) parameter to predict the failure of first line treatment
Colonic wall vascularization will be assessed according to the Limberg score to identify two subgroups: 1) increased vascularization (Limberg score 3-4); 2) normal colonic wall flow (Limberg Score 0-2). Such classification will be used, measured within the first 48 hours from i.v. steroid initiation, to predict failure of first line treatment (according to the latest ESPGHAN guidelines)
Time frame: Within 48 hours from i.v. steroid treatment initiation
Mesenteric lymph nodes BUS (bowel ultrasound) parameter
Presence of enlarged mesenteric lymph nodes, defined by short axis \> 5 mm it will be assessed within 48 hours from i.v. steroid treatment initiation, to predict the failure of first line treatment (defined according to the latest ESPGHAN guidelines)
Time frame: Within 48 hours from i.v. steroid treatment initiation
evaluation of the prognostic value of the ultrasound parameters
evaluation of the prognostic value of the ultrasound parameters in predicting the possible failure of second-line therapy and therefore the need to carry out colectomy surgery
Time frame: Within 48 hours from second-line therapy initiation
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