P070 Outcomes of Acute Severe Ulcerative Colitis in Older Adults.

Abstract

BACKGROUND: Approximately 40% of patients with acute severe ulcerative colitis (ASUC) do not respond to steroids. There is paucity of data on the outcomes of ASUC in the older adults (≥60 years of age). The primary objective of our study was to assess steroid failure rate. The secondary outcomes assessed were need for colectomy during same admission, at 3 and 12 months; mortality during admission for ASUC, at 3 months and 12 months. METHODS: All admissions for ASUC (fulfilling Truelove and Witts Criteria) between January 1, 2015 and July 31, 2020 at Gold Coast University Hospital and from January 1, 2018 to July 31, 2020 at Logan Hospital were analysed. Review of electronic medical records was performed and clinical, endoscopic, laboratory data were collected. Steroid failure was defined as need for rescue therapy (medical or surgical). For comparisons of proportions, we used Pearson's chi-square analyses or Fisher's exact tests. Non-parametric data were compared using Kruskal-Wallis test. Parametric data were compared using paired t-test. To test for independent predictive factors a logistic regression model was constructed with steroid failure as the dependent variable. RESULTS: We analyzed 194 episodes (153 patients) of ASUC, of which 41 episodes (32 patients) were in patients who were ≥ 60 years of age at the time of ASUC event. 29 episodes (23 patients) in whom UC was diagnosed ≥60 years of age. Fourteen (43.75%) female, median disease duration 2 years (0–6), median Charlson Comorbidity Index 3 (2–4). Fourteen (34.1%) episodes occurred in patients on biological therapy (6 on anti-TNF antagonists, 8 on Vedolizumab), 15 (36.6%) episodes were on oral corticosteroids at admission. Eighteen (43.9%) required rescue therapy (2 episodes underwent colectomy, 16 episodes received medical rescue therapy (11 infliximab, 5 cyclosporine); 7 patients received IFX 5 mg/kg, 4 patients received IFX 10 mg/kg. In adults ≥60 years, 5 (12.2%) episodes had a colectomy during the admission for ASUC (vs 7.8% in adults < P 0.0001) when compared to patients < 60 years of age. There was no mortality in patients < 60 years of age. On univariate analysis of admission variables. albumin (OR 0.83, P 0.015, CI 0.70–0.96), CRP (OR 1.01, P 0.033, CI 1.00–1.02), UCEIS score (OR 3.68, P 0.016, CI 1.27–10.60) were significant for predicting steroid failure. On multivariate regression analysis, UCEIS score and albumin remained significant. CONCLUSION: In patients who are ≥ 60 years of age, steroid failure rate, the need for colectomy during the same admission and colectomy at 12 months is similar to a population.