Outcome In Severe Ulcerative Colitis Research Articles

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

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.

OC-002 Predicting Outcome In Acute Ulcerative Colitis: Comparison Of The Travis And Ho Scores Using Uk Ibd Audit Data

IntroductionPatients with severe Ulcerative Colitis (UC) are commonly identified using the Truelove and Witts1 criteria on presentation. The Travis2 and Ho3 scores are subsequently used to identify patients with severe...

Early predictors of responses and clinical outcomes of corticosteroid treatment for severe ulcerative colitis

Background. Patients with severe ulcerative colitis (SUC) have a high risk of requiring colectomy or resorting to a second-line treatment. However, neither clinical outcomes nor factors predictive of poor response have been clearly established in the treatment of SUC. Objective. To assess prospectively the effects and predictors of corticosteroids (CS) use in clinical outcomes of SUC during 1 year of follow-up. Material and methods. Consecutive inpatients with SUC, who had been treated with intravenous CS, were enrolled. Patients were monitored by clinical, laboratory, and endoscopic examinations, and the data were recorded for 1 year. Univariate and multivariate analyses were performed at 1 week. Results. There were 22.6% (14/62) nonresponders at 7 days. Several predictors were associated with nonresponse to CS. These included Mayo Score at baseline (p = 0.007), partial Mayo Score, number of bowel movements, blood presence in stool, abdominal pain, and levels of C-reactive protein (CRP), hemoglobin (Hgb), platelet count (PLT), and erythrocyte sedimentation rate (ESR) on day 3 (p < 0.05). Multiple logistic regression analysis identified the Partial Mayo Score at day 3 as an independent predictor of outcome (p = 0.012). A total of 12 patients underwent colectomy within 1 year. The short-term response rates to intravenous cyclosporin (CsA) and infliximab (IFX) in SUC were 71.4% (5/7) and 77.8% (7/9), respectively. Conclusions. Many patients with SUC eventually became refractory to or dependent on CS. The Mayo score and laboratory characteristics were factors useful in predicting short-term outcome of CS treatment. Secondary medical therapy can help avoid emergency surgery.

Long-term outcome after admission for acute severe ulcerative colitis in Oxford: The 1992–1993 cohort

To determine the long-term outcome of patients admitted with acute severe colitis (ASC) who avoided colectomy on the index admission, a retrospective cohort study was performed. Patients admitted for intensive treatment of ASC in 1992-1993 previously described for a predictive index of short-term outcome in severe ulcerative colitis (UC) were followed for a median 122 months (range 3-144). Complete responders (CR) to intensive therapy had <3 nonbloody stools/day on day 7 of the index admission; incomplete responders (IR) were all others who avoided colectomy on that admission. Main outcome measures were colectomy-free survival, time to colectomy, and duration of steroid-free remission. In all, 6/19 CR (32%) came to colectomy compared to 10/13 IR (P = 0.016; relative risk 3.33, 95% confidence interval [CI] 1.12-9.9). The median +/- interquartile range time to colectomy was 28 +/- 47 months (range 6-99) for CR who came to colectomy versus 7.5 +/- 32 (3-72) months for IR (P = 0.118). Among the IR, 7/13 came to colectomy within 12 months, and all within 6 years from the index admission. The longest period of steroid-free remission was 42 +/- 48 (0-120) months for CR, but 9 +/- 20 (1-35) months for IR (P = 0.011). One week after admission with ASC in the prebiologic era, IRs had a 50% chance of colectomy within a year and 70% within 5 years, despite cyclosporin and azathioprine where appropriate. The maximum duration of remission in CRs was almost 5 times longer than IRs. It is unknown whether biologics change the long-term outcome.

Clinical manifestations and outcomes in severe ulcerative colitis

In order to evaluate the clinical manifestations and outcomes of severe ulcerative colitis (UC), we retrospectively reviewed 41 patients with severe UC from 144 consecutively hospitalized UC cases from 1988 to 2004. Data recorded included onset, symptoms, signs, laboratory results, endoscopic, radiologic and pathologic findings, the clinical treatment process and follow-up. Of these severe cases, 92.7% (38/41) had pancolitis. Clinically, 36.9% (15/41) were categorized as first onset type, 36.9% (15/41) were chronic persistent and 26.8% (11/41) were chronic recurrent. Steroids played a main role in the remission of severe UC (61.0%). Thirty-one cases (75.6%) were relieved by drug therapy. Seven cases (17.1%) progressed to the need for operation. An early age of onset, pancolitis, low hemoglobin and serum albumin levels, and the need for intravenous steroids tended to be associated with the need for surgery. In conclusion, most of the severe UC patients respond well to drug therapy, but for individuals who are unresponsive to drug therapy, or for those depending on steroids, after a reasonable duration of treatment, the necessity for surgery should be considered.

US ESTIMATES AND OUTCOMES OF CHILDREN AND ADOLESCENTS HOSPITALIZED WITH ULCERATIVE COLITIS

Randomized trials in children are needed to assess the efficacy of novel therapeutic agents in hospitalized patients with ulcerative colitis (UC). However, there are limited data describing the epidemiology and outcomes of severe ulcerative colitis in children. Purpose: To estimate the number and outcomes of US children hospitalized with ulcerative colitis. Methods: We analyzed the Kids' Inpatient Database, a nationwide and stratified probability sample of 2.5 million hospital discharges from the year 2000 of children 20 years and younger. Ulcerative colitis was defined as discharges 18 years and younger, with a discharge ICD-9 diagnosis code of 556.0-556.9 in the first position. Those undergoing colectomy were identified using the ICD-9 code 45.8 as the principal procedure performed during hospitalization. Weighted estimates (±SD) are reported, and represent US national estimates. Results: A total of 7.3 million discharges were available for analysis. 2,277 (±209) children 18 years and younger were hospitalized for ulcerative colitis. 893 (±106) were hospitalized for 7 days or longer, and 207 (±45) underwent total abdominal colectomy. Among the 2,784 reporting hospitals, twenty reported more than 10 cases of UC requiring 7 days or longer of hospitalization. Conclusions: Approximately 40% of all children hospitalized for UC required 7 days or longer of hospitalization, and 9% required colectomy. UC cases requiring prolonged hospitalization are relatively rare and widely distributed. These data clearly demonstrate that clinical trials designed for the treatment of refractory colitis will require a multi-institutional collaborative network.

Predicting outcome in severe ulcerative colitis

Predicting outcome in severe ulcerative colitis

Predicting outcome in severe ulcerative colitis

Predicting outcome in severe ulcerative colitis

Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second-line medical therapy or surgery.

The failure rate of medical therapy in severe ulcerative colitis is high. A risk index, to aid the identification of patients of not responding at an early stage to intravenous corticosteroid therapy, would be useful to facilitate second-line treatment or surgery. We recruited 167 consecutive patients with severe ulcerative colitis between January 1995 and March 2002; and employed multiple logistic regression to analyse parameters within the first 3 days of medical therapy. We applied statistical modelling to formulate a risk score according to the likelihood of medical failure. Sixty-seven (40%) patients failed to respond to medical therapy. Multiple logistic regression analysis identified mean stool frequency and colonic dilatation within the first 3 days and hypoalbuminaemia as independent predictors of outcome (P < 0.001, 0.001 and 0.002 respectively). A numerical risk score was formulated based on these variables. Patients with scores of 0-1, 2-3 and > or =4 had a medical therapy failure rate of 11%, 43% and 85% respectively. Receiver-operator characteristic analysis of this score yielded area under curve of 0.88, with a sensitivity of 85% and specificity of 75% using score > or =4 in predicting non-response. This risk score allows the early identification of patients with severe ulcerative colitis who would be suitable for second-line medical therapy or surgery.

Predicting therapeutic outcome in severe ulcerative colitis by measuring in vitro steroid sensitivity of proliferating peripheral blood lymphocytes

BACKGROUNDUp to 29% of patients with severe ulcerative colitis (UC) fail to respond to steroid treatment and require surgery. Previous studies have failed to show a clear correlation between failure...

Predicting outcome in severe ulcerative colitis.

Simple criteria are needed to predict which patients with severe ulcerative colitis will respond poorly to intensive medical treatment and require colectomy. To find out if the early pattern of change in inflammatory markers or other variables could predict the need for surgery and to evaluate the outcome of medical treatment during one year follow up. 51 consecutive episodes of severe colitis (Truelove and Witts criteria) affecting 49 patients admitted to John Radcliffe Hospital, Oxford. Prospective study monitoring 36 clinical, laboratory, and radiographic variables. All episodes treated with intravenous and rectal hydrocortisone and 14 of 51 with cyclosporine. Complete response in 21 episodes (< or = 3 stools on day 7, without visible blood), incomplete response in 15 (> 3 stools or visible blood on day 7, but no colectomy), and colectomy on that admission in 15. During the first five days, stool frequency and C reactive protein (CRP) distinguished between outcomes (p < 0.00625, corrected for multiple comparisons) irrespective of whether patients or the number of episodes were analysed. It could be predicted on day 3, that 85% of patients with more than eight stools on that day, or a stool frequency between three and eight together with a CRP > 45 mg/l, would require colectomy. For patients given cyclosporine, four of 14 avoided colectomy but two continued to have symptoms. After admission, complete responders remained in remission for a median nine months and had a 5% chance of colectomy. Incomplete responders had a 60% chance of continuous symptoms and 40% chance of colectomy. After three days intensive treatment, patients with frequent stools (> 8/day), or raised CRP (> 45 mg/l) need to be identified, as most will require colectomy on that admission. The role of cyclosporine for treating severe colitis has yet to be defined. After seven days' treatment, patients with > 3 stools/day of visible blood have a 60% chance of continuous symptoms and 40% chance of colectomy in the following months.