Acute Severe Ulcerative Colitis (ASUC) affects 15% of patients with Ulcerative Colitis. The current standard of care is intravenous (IV) steroids, with ciclosporin or anti-TNF as second line medical therapy and urgent colectomy when medical therapy fails. Previous data from our centre reports 40% of those admitted with ASUC required colectomy. We aimed to determine predictors of outcome in patients admitted with acute UC.Methods
Patients admitted to NHS Lothian hospitals between 1/11/13 and 31/10/16 requiring IV steroids for UC were identified using ICD10 discharge codes. Only the first admission for each patient during that period was included. Case record review verified the diagnosis and collected clinical variables including age, sex, disease activity (Mayo endoscopic severity score) and distribution, and treatments needed. Response to therapy was defined as discharge from hospital requiring no further anti-inflammatory treatment. Comparisons were made using Kruskal-Wallace or chi-squared analyses where appropriate.Results
173 patients were identified (62% male, median age 39.67 years (IQR 29.58–54.75)). 108/173 (63%) responded to IV steroids, 29/173 (17%) responded to second line medical therapy and 35/173 (20%) patients required colectomy. One patient died from complications of concurrent disease.Results
Endoscopic assessment more closely reflected response to intravenous steroids than stool frequency. 96% of those with mild endoscopic disease responded to IV steroids, compared to 40% of those with severe endoscopic disease (p<0.001). 70% of those with stool frequency <4/day responded to steroid therapy compared to 62% of those with >6 stools/day (p=0.028). Endoscopy was performed on day 2 on average (IQR 1–3) (figure 1).Results
Those requiring surgery had a shorter disease duration compared with those responding to IV steroids (median 0.13 years vs 1.5 years, p=0.09 Kruskal-Wallace). The median length of admission was 7.5 days (IQR 6–16) and surgery was performed on day 9 (IQR 8–12) on average. Age, sex, disease extent at diagnosis and smoking status were similar between groups.Conclusions
20% of patients admitted to hospital for IV steroid treatment for active UC required urgent colectomy during admission. Response to steroids was greater in those with less severe endoscopic disease with a clearer relationship between endoscopic severity and response than stool frequency on admission. Those requiring surgery were likely to have a shorter disease duration on admission. These data emphasise the need for a timely endoscopic assessment for all patients admitted with acute colitis.