Background Readmission shortly after discharge is indicative of an increased disease severity for patients with ulcerative colitis (UC) and ineffectiveness to medical therapy, which may contribute to a dismal prognosis. Objectives This study aimed to explore prognostic variables with a nomogram to predict unplanned UC-related readmission within 1 year after discharge. Design A retrospective cohort study. Methods Electronic medical records of all UC patients treated at our center between 1 January 2014 and 31 June 2021 were reviewed. A comprehensive analysis of various characteristics, such as demographics, comorbidities, medical history, follow-up appointments, admission endoscopy, histopathologic features, etc., was used to determine the primary end point, which was unplanned UC-related calendar year readmission. Results We found that the unplanned UC-related readmission rate within 1 year was 20.8%. In multivariable cox analysis, the predictors of the Elixhauser comorbidity index [Hazard ratio (HR): 3.50, 95% confidence interval (CI): 1.93-6.37], regular follow-up (HR: 0.29, 95% CI: 0.16-0.53), any history of corticosteroid use (HR: 3.38, 95% CI: 1.83-6.27), seral level of C-reactive protein (HR: 1.01, 95% CI: 1.00-1.02), and the UC endoscopic index of severity (HR: 1.29, 95% CI: 1.05-1.57) independently predicted calendar year readmission after discharge. The established nomogram had a consistently high accuracy in predicting calendar year readmission in the training cohort, with a concordance index of 0.784, 0.825, and 0.837 at 13, 26, and 52 weeks, respectively, which was validated in both the internal and external validation cohorts. Therefore, UC patients were divided into clinically low-, high-, and extremely high-risk groups for readmission, based on the calculated score of 272.5 and 378. Conclusion The established nomogram showed good discrimination and calibration powers in predicting calendar year readmission in high-risk UC patients, who may need intensive treatment and regular outpatient visits.

中文翻译：

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基于临床因素的列线图，用于预测溃疡性结肠炎患者的历年再入院情况。

背景 出院后不久再次入院表明溃疡性结肠炎 (UC) 患者的疾病严重程度增加且药物治疗无效，这可能导致预后不良。目的 本研究旨在通过列线图探索预后变量，以预测出院后 1 年内与 UC 相关的意外再入院情况。设计一项回顾性队列研究。方法回顾2014年1月1日至2021年6月31日期间在我中心治疗的所有UC患者的电子病历。对各种特征（如人口统计、合并症、病史、随访预约、入院内镜检查、组织病理学特征等）的综合分析用于确定主要终点，即与 UC 相关的日历年计划外再入院。结果我们发现1年内与UC相关的非计划再入院率为20.8%。在多变量 cox 分析中，Elixhauser 合并症指数的预测因子 [风险比 (HR)：3.50，95% 置信区间 (CI)：1.93-6.37]，定期随访（HR：0.29，95% CI：0.16-0.53） ）、任何皮质类固醇使用史（HR：3.38，95％CI：1.83-6.27）、C反应蛋白血清水平（HR：1.01，95％CI：1.00-1.02）以及UC内镜严重程度指数（ HR：1.29，95% CI：1.05-1.57）独立预测出院后的历年再入院。建立的列线图在预测训练队列中历年再入院方面具有一贯的高精度，第 13、26 和 52 周的一致性指数分别为 0.784、0.825 和 0.837，这在内部和外部验证中得到了验证队列。因此，根据计算得分 272.5 和 378，将 UC 患者分为再入院的临床低风险组、高风险组和极高风险组。 - UC 风险患者，可能需要强化治疗和定期门诊就诊。