For patients with acute severe ulcerative colitis (ASUC) who responded to intravenous corticosteroids (IVCS) or rescue therapy with infliximab (IFX), low serum albumin levels and colonic dilation were risk factors for long-term colectomy, according to study findings published in the Journal of Clinical Medicine.
Patients (N=116) with ulcerative colitis (UC) who were admitted to Tor Vergata University in Italy between 2010 and 2020 for severe relapse were included in the study. All patients were successfully treated with IVCS (60 mg/day) or second-line IFX (5 mg/day). Response to IVCS was defined as up to 3 bowel stools per day with no visible bleeding. Rescue IFX was administered if IVCS response was not achieved by day 5. Patients were evaluated for colectomy risk factors.
Most patients (85%) responded to IVCS. During a median follow-up of 46 months, 25% of patients underwent colectomy.
Patients who did not (n=87) and did (n=29) undergo colectomy during follow-up were 41% and 72% women or girls (P =.005); had a median age of 43 (range, 16-86) and 55 (range, 24-85) years; 15% and 34% had previously received anti-tumor necrosis factor (TNF) therapy (P =.029); 34% and 65% had steroid dependence (P =.04); mean Partial Mayo Clinic scores were 6.7±1.03 and 7.3±1.11 (P =.02); median C-reactive protein (CRP) levels were 38 (IQR, 0.1-242) and 84 (range, 9.5-258) mg/dL (P =.02); albumin levels were 3.2 (range, 1.6-4.5) and 2.8 (range, 1.7-4.3) g/dL (P =.04); and colonic dilation was 3.1 (range, 2.1-6) and 4.6 (range, 3.2-6.9) cm, respectively.
During the follow-up period, more patients who underwent colectomy were re-hospitalized (P <.0001) and required steroids (P =.018).
In the univariate analysis, significant predictors for colectomy included low albumin (P <.0001), colonic dilation (P =.0016), steroid dependence (P =.007), sex (P =.01), high CRP (P =.034), and pervious anti-TNF use (P =.04).
In the multivariate analysis, albumin lower than 3 g/dL (odds ratio [OR], 6.887; 95% CI, 2.08-22.8; P =.002) and colonic dilation greater than 5.5 cm (OR, 8.468; 95% CI, 1.23-58.3; P =.03) remained associated.
Low serum albumin (area under the receiver operating characteristic curve [AUC ROC], 0.765; P <.001) and colonic dilation (AUC ROC, 0.833; P <.001) were significant predictors for colectomy.
At 5 years, the colectomy-free survival rate was 93% among patients with neither low albumin nor colonic dilation, 76% for either low albumin or colonic dilation, and 14% for patients with both low albumin and colonic dilation.
The major limitation of this study was that no comparison could be made between patients who responded to IVCS with those who required rescue IFX due to limited power.
This study found that patients with ASCUC who presented with low serum albumin and/or colonic dilation at hospital were at increased risk for colectomy at up to 5 years.
Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original reference for a full list of authors’ disclosures.
De Cristofaro E, Salvatori S, Marafini I, et al. Long-term risk of colectomy in patients with severe ulcerative colitis responding to intravenous corticosteroids or infliximab. J Clin Med. 2022;11(6):1679. doi:10.3390/jcm11061679