Early Intestinal Ultrasound in Severe Ulcerative Colitis Identifies Patients at Increased Risk of 1-Year Treatment Failure and Colectomy

Abstract

Abstract Background and Aims Reliable and easily accessible objective markers of disease activity to predict long-term treatment outcomes in severe ulcerative colitis [UC] are missing. We aimed to investigate if intestinal ultrasound [IUS] might predict long-term outcomes in hospitalised patients with severe UC, treated with intravenous [IV] corticosteroids. Methods Hospitalised patients with severe UC and IUS inflammation (bowel wall thickness [BWT] > 3.0 mm) starting IV corticosteroids were recruited at three university hospitals in Denmark. IUS was performed before treatment and 48 ± 24 h, 6 ± 1 days, and 3 months after treatment initiation. Time until colectomy or need for new interventions was registered together with Mayo score at 3 months and partial Mayo score [pMayo] at 12 months. Follow-up time was 12 months. Results In the final analysis, 56 patients were included; 45 [80%] patients needed intervention, including nine colectomies, during the 12-month follow-up. After 48 ± 24 h, no patient with a BWT < 3 mm needed a colectomy, p = 0.04. BWT ≥ 4 mm showed an increased risk of colectomy {odds ratio 9.5 (95% confidence interval [CI] 1.5–186), p = 0.03}, whereas a BWT ≥ 3 mm showed an increased risk of intervention (3.6 [1.1–12.5], p = 0.03). A BWT ≥ 4 mm resulted in a significantly shorter time until both colectomy, p = 0.03, and treatment intensification (mean days 75 [95% CI 24–127] vs 176 [119–233], p = 0.005). However, neither IUS parameters nor pMayo score, C-reactive protein [CRP], haemoglobin, or p-albumin could predict remission at 3 and 12 months. Conclusion BWT, assessed at 48 h post intravenous corticosteroid initiation in patients hospitalised with severe UC, may identify patients with an increased risk of short- and long-term colectomy and predict a more aggressive short-term disease course.