Patients with acute severe ulcerative colitis (ASUC) who receive ambulatory care have similar rates of colectomy compared with those who receive traditional inpatient care, according to a study in BMJ Open Gastroenterology.
Researchers used data from the PROTECT study, which compared ASUC outcomes in the first wave of the COVID-19 pandemic in 2020 with those in a prepandemic cohort from 2019 at 60 acute secondary care hospitals in the United Kingdom. Inclusion criteria included age ≥18 years, ASUC according to Truelove and Witts criteria, and ASUC diagnosis from March 1, 2020, to June 30, 2020 (COVID-19 pandemic period) or from January 1, 2019, to June 30, 2019 (prepandemic period). The primary outcome was the proportion of patients who required colectomy in the index ASUC management period.
The cohort of 764 patients were categorized into 3 groups — those who were inpatients for the entirety of their case (n=695; median age, 37.0 years; 50.1% women), and an ambulatory cohort of 70 patients who were subgrouped into those who were managed as ambulatory from diagnosis (n=15; median age, 30.0 years; 53.3% women), and those who were managed initially as inpatients but were then discharged to ambulatory care (n=54; median age, 44.5 years; 38.9% women).
The proportion of patients who needed a colectomy during their index ASUC management period was similar in the 3 treatment pathways: inpatients, 15.0% (104/695); ambulatory from diagnosis, 13.3% (2/15); and discharged to ambulatory, 13.0% (7/54) (P =.87). Participants in the 3 groups also had a comparable response to intravenous corticosteroids, time to and rate of rescue or primary induction treatment, and time to colectomy, mortality, and duration of inpatient treatment.
Among the inpatients, 18 of 690 (2.6%) vs no patients in ambulatory group received biologic rescue/induction without initially receiving intravenous corticosteroids. A trend was observed, although it was not significant, for patients who received ambulatory care from diagnosis as being more likely to receive rescue or primary induction treatment; however, these patients were less likely to respond to these therapies compared with those in the other treatment groups.
No significant differences were found in the rates of UC flare, readmission to hospital with UC flare, or colectomy among the cohorts after 3 months from the index ASUC diagnosis.
Study limitations include the relatively small number of patients in the ambulatory groups and the potential of selection bias towards the null regarding the measured outcomes. In addition, the ambulatory pathways used at each center were likely different, and the investigators did not obtain patient feedback on the acceptability and perceived effectiveness of these pathways.
“We recommend that patients managed in the ambulatory setting are reviewed by gastroenterologists daily to monitor clinical parameters and assess for potential complications including venous thromboembolism and biochemical disturbance,” the researchers commented. “Ambulatory ASUC care represents an ambitious target for transformational care within the [inflammatory bowel disease] management.”
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Sebastian S, Patel KV, Segal JP, et al. Ambulatory care management of 69 patients with acute severe ulcerative colitis in comparison to 695 inpatients: insights from a multicentre UK cohort study. BMJ Open Gastroenterol. 2022;9(1):e000763. doi: 10.1136/bmjgast-2021-000763