Rubio-Tapia et al reported a clinical staging system for patients with refractory celiac disease. The authors are from the Mayo Clinic in Rochester.
Patient selection: refractory celiac disease
Parameters:
(1) age in years
(2) hemoglobin in g/dL
(3) serum albumin in g/dL
(4) T-cell clone in intra-epithelial lymphocytes
(5) total villous atrophy in small bowel biopsy
|
Parameter |
Finding |
Hazard Ratio |
Points |
|---|---|---|---|
|
age in years |
< 50 years |
1 |
0 |
|
|
50 to 64 years |
2.3 |
0 |
|
|
>= 65 years of age |
4.5 |
1 |
|
hemoglobin |
> 11 g/dL |
1 |
0 |
|
|
<= 11 g/dL |
3.4 |
1 |
|
albumin |
> 3.2 g/dL |
1 |
0 |
|
|
<= 3.2 |
9.1 |
1 |
|
T-cell clone |
no |
1 |
0 |
|
|
yes |
2.5 |
1 |
|
total villous atrophy |
no |
1 |
0 |
|
|
yes |
2.4 |
1 |
where:
• There is no gender difference in the hemoglobin cut-off.
• Overall survival in RCD2 (presence of aberrant T-cell clone) is worse than for RCD1 (absence of aberrant T-cell clone) as shown in Figure 1.
• The staging system treats the factors as equal although the hazard ratio for albumin is almost 4 times the HR of total villous atrophy. Age 50 to 64 years has the same hazard ratio as total villous atrophy and is not counted.
cumulative hazard ratio =
= PRODUCT(hazard ratios)
number of adverse prognostic factors =
= SUM(points for the 5 parameters)
Interpretation:
• minimum number of prognostic factors: 0
• maximum number of prognostic factors: 5
• Survival declines as the number of adverse prognostic factors increase.
|
Number of Adverse Prognostic Factors |
Stage |
5-Year Survival in Figure 2 |
|---|---|---|
|
0 or 1 |
I |
96% |
|
2 or 3 |
II |
71% |
|
4 or 5 |
III |
19% |
Specialty: Gastroenterology, Nutrition
ICD-10: ,
