Early predictors of rescue therapy and colectomy in acute severe ulcerative colitis.
10.4103/singaporemedj.SMJ-2024-242
- Author:
Samuel Jun Ming LIM
1
;
Kaina CHEN
1
;
Yi Yuan TAN
1
;
Shu Wen TAY
1
;
Thomson Chong Teik LIM
1
;
Ennaliza SALAZAR
1
;
Webber Pak-Wo CHAN
1
;
Malcolm Teck Kiang TAN
1
Author Information
1. Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
- Publication Type:Journal Article
- Keywords:
Colitis;
inflammatory bowel diseases;
risk assessment;
ulcerative
- MeSH:
Humans;
Colitis, Ulcerative/therapy*;
Colectomy;
Retrospective Studies;
Male;
Female;
Middle Aged;
Adult;
C-Reactive Protein/metabolism*;
Infliximab/therapeutic use*;
Biomarkers/blood*;
Acute Disease;
Aged;
Severity of Illness Index;
Treatment Outcome
- From:Singapore medical journal
2025;66(8):449-456
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Acute severe ulcerative colitis (ASUC) is a significant cause of disease morbidity. One-third of patients with ASUC are steroid refractory. Rescue therapy may not successfully induce remission, necessitating colectomy. We aimed to identify predictors of rescue therapy and colectomy in ASUC assessed within 24 h of admission for early risk stratification.
METHODS:We conducted a retrospective cohort study of 58 admissions for ASUC among 47 patients from August 2002 to January 2022. Serum biomarkers assessed were measured on admission. Primary outcomes were the need for rescue therapy during the same admission and colectomy within 1 year of admission.
RESULTS:Rescue therapy (all with infliximab) was given in 20 (34.5%) of the admissions. Colectomy was done within 1 year for nine (15.5%) of the admissions. An elevated C-reactive protein (CRP) of >30 mg/L (relative risk [RR] 1.63), a CRP-albumin ratio of >0.85 (RR 1.63), and a composite factor of both CRP > 30 mg/L and age ≥60 years (RR 2.37) were significantly associated with the need for rescue therapy. Hypoalbuminaemia ≤ 25 g/L (RR 4.35) and the use of biologics at presentation (RR 1.54) were significantly associated with colectomy within 1 year of admission, while a CRP of ≥ 80 mg/L was a significant protective factor (RR 0.70).
CONCLUSION:Patients with ASUC who have elevated CRP or CRP-albumin ratio on admission should be considered at risk for steroid-refractory disease. Those with hypoalbuminaemia on admission and using biologics at presentation are more likely to require colectomy in the first year after admission for ASUC.
