Therapeutic Response to Glucocorticoids and Predictive Factors in Severe Ulcerative Colitis
10.3969/j.issn.1008-7125.2019.07.003
- Author:
Mingtao LI
1
Author Information
1. Department of Gastroenterology, Anhui Provincial Hospital Affiliated to Anhui Medical University
- Publication Type:Journal Article
- Keywords:
Forecasting;
Glucocorticoids;
Risk Factors;
Severe Ulcerative Colitis;
Therapy
- From:
Chinese Journal of Gastroenterology
2019;24(7):395-399
- CountryChina
- Language:Chinese
-
Abstract:
Background: Intravenous glucocorticoids (GCs) are the first-line therapy of severe ulcerative colitis (SUC), however, part of the SUC patients are steroids-refractory. Aims: To investigate the predictive factors of therapeutic response to GCs and whether prolonging GCs therapy is beneficial for patients with SUC. Methods: Data of patients with SUC admitted in Anhui Provincial Hospital from Jan. 2006 to Dec. 2017 were collected consecutively. Patients were categorized into different groups according to the responsiveness to intensive intravenous GCs therapy on day 7 and day 14 (in prolonged treatment group), and their general conditions, clinical, laboratory, endoscopic, pathological features and outcomes were compared and analyzed for finding the predictive factors. Results: Complete remission and partial remission was achieved on day 7 in 20 (22.7%) and 43 (48.9%) of the 88 SUC patients, respectively, and the other 25 cases (28.4%) were non-responders. Univariate analysis revealed that defecation >10 times on admission, >6 times on day 3, bloody stool on day 3, pancolitis, and abnormal laboratory findings including ESR and albumin (ALB) on admission, and CRP and CRP/ALB ratio on admission and on day 3, were associated with poor response to GCs (P<0.05). Multivariate analysis showed that ESR>40 mm/h on admission and defecation >6 times on day 3 were the independent risk factors for treatment failure of GCs (P<0.05). Compared with the complete remission group, characteristic endoscopic findings, especially extensive mucosal abrasion were seen more frequently in partial remission group and non-responders (P<0.05). In patients with partial remission and non-responders, 14-day prolonged GCs therapy achieved complete remission in 18 cases (26.5%). Conclusions: ESR>40 mm/h on admission and defecation >6 times on day 3 might be the independent predictors for poor response to GCs in patients with SUC. A small part of SUC patients with partial remission on day 7 can achieve complete remission by prolonged (14-day) GCs therapy.
