P381 Factors predicting risk of colectomy in patients receiving first line steroid and second line biologic salvage therapy for Acute Severe Ulcerative Colitis

Abstract

Abstract Background Acute severe ulcerative colitis (ASUC) is considered a medical emergency and is associated with high rates of colectomy and even death. Intra-venous corticosteroids serve as first line therapy for ASUC. Patients who fail to respond will progress to rescue therapy, comprised of either medical therapy (with Cyclosporine or Infliximab) or colectomy. We aimed to detect factors predictive of first and second line therapy failure in patients hospitalized for ASUC. Methods The Sheba Medical Center database was screened for all hospitalized UC patients between, 2009–2019. All clinical, demographic and laboratory parameters were retrieved from patients’ medical files. All parameters were compared between patients either responding to or failing corticosteroids / second line therapy, respectively. All statistical analyses were performed using the MEDCALC software. Results 159 hospitalized ASUC patients were identified (117, 73.6% responded to IV corticosteroids;, 42, 26.4% failed first line therapy). 4 (9.5%) of those who failed first line therapy underwent colectomy. The only factor predisposing for corticosteroid therapy failure was pervious biological therapy. No statistically significant difference was observed in terms of MAYO score at admission, UC location, smoking, previous hospitalizations, hemoglobin levels or fever upon admission., 25 patients responded to second line biological therapy (15 Infliximab, 8 Cyclosporine, 2 Tofacitinib) while, 13 failed this therapy (6 Infliximab, 7 Cyclosporine). The only factors predicting second line therapy failure were previous biological therapy (p=0.01) and pancolitis at presentation (p=0.04). Conclusion ASUC patients previously treated with biologics and who had pancolitis at diagnosis are at higher risk of second line therapy failure and colectomy.